Post a Manual Remit

When you receive remittance advice from a payer outside of the system, you'll need to record that information in the system so you can finalize its claims to the next payer or to the billing account. Follow the steps in each section below to record a Remit.

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Add the Remit

1. Go to Billing > Remittance > Received to add a remit you have received from a payer.
   
    
2. In the lower right of the Received Remittance page, click the + Remittance button.
3. Fill in information about the remit.

   Payer	The payer who sent the remit. You can either select a payer or type in a custom name.  (Required)
   Date	The date of the remit's payment. (Required)
   Amount	The total amount the payer paid in the remit. (Required)
   Type	Indicates whether the remit was paid by check or EFT. (Required)
   Number	The payment's reference number, such as a check number. (Helpful, but not required)
   Billing Provider	The name of the billing provider listed on the remit. (Optional and can be left blank)
   Identifier Type	Indicates whether the remit refers to the billing provider with an NPI or Tax ID. (Optional and can be left blank)
   Provider NPI / TIN	The NPI or TIN listed on the remit for the billing provider. (Required only if you selected an Identifier Type)

4. Click the Save Remittance button.

   TIP! You can upload a copy of the remit's original file as a PDF. Check out this article on how to upload a PDF to a Manual Remit.

Link Claims to the Remit
 

Once you have a remit in the system, link it to each claim the remit applies to.

1. Go to Billing > Remittance > Received, then click the remit you want to link claims to.

   

   
    
2. In the lower right, click the + Claim button.

   

   
    
3. Select the checkbox next to one or more claims.
4. Click the Link claims to remittance button.

   

    

• Click the Filter icon, then select the checkboxes next to the filter options to add filters to the Claim List.
   

  

  
   
• If you don't see the claim you're looking for: Click the Remitter filter and select Clear, then click the Phase filter and select Clear.
   
• If you need to link multiple dates of service for one patient to the remit: Click the Patient filter, select the patient name, then click Apply to see a list of claims for that patient. Then, select the checkboxes for each claim for the dates of service you need.

  

  
   

Fill In Adjudication Information
 

For each claim in the remit, fill in the adjudication information, which indicates how and why the payer paid the claim.

1. From the list of claims linked to a remit, click the claim you want to fill in adjudication information for.
2. If needed, modify the information in the Summary tab.  Most of this section will automatically be filled in.

   Date	The date this claim was processed by the payer.
   Reference	The reference number the payer assigned to the claim.
   Patient	The patient's name on the claim.
   Insured Name	The insured's name on the claim.
   Insured ID	The insured's ID number on the claim.
   Group Number	The insured's group number on the claim.
   Notes	Notes about this adjudication that you want to save for your reference.

3. For each Line table, fill in information about how the payer paid toward that service line.  When all of the charges submitted for the line have been allocated, the amount remaining above the Date of Service will show .

    

   TIP: If you need to add a new line to the adjudication, click the + Line button in the lower right.

    

   Date of Service	The date of service this line applies to.
   Procedure Code	The billing code that was processed by the payer for this line.
   Charges Submitted	The charge amount for this line that was submitted to the payer.
   Charges Paid	The amount that was paid by the payer for this line.
   Units Submitted	The number of units for this line that was submitted to the payer.
   Units Paid	The number of units that were paid by the payer for this line.
   Allowed Amount	The portion of the charge amount that this payer allows.
   Not Allowed	The portion of the charge amount that is beyond what the payer allows. This amount is saved as a "contractual obligations" adjustment (code 45).
   Other Payers	The portion of the charge amount that has already been paid by, or should be paid by, another payer. This amount is saved as an "other" adjustment (code 23).
   Co-Pay	The portion of the charge amount that the patient owes as a co-pay. This amount is saved as a "patient responsibility" adjustment (code 3).
   Deductible	The portion of the charge amount that the patient owes as a deductible. This amount is saved as a "patient responsibility" adjustment (code 1).
   Co-Insurance	The portion of the charge amount that the patient owes as co-insurance. This amount is saved as a "patient responsibility" adjustment (code 2).
   Submitted Code	The billing code for this line that was submitted to the payer.
   Adjustments	Add any additional adjustments the payer used to process the line here. Click the adjustment codes icon  to look up a description of the saved code.
   Remarks	Add any remark codes the payer used to process the line here. Click the remark codes icon  to look up a description of the saved code.

4. If needed, fill in the information in the Claim tab about how the payer adjudicated the overall claim. This is not common and should only be modified if the payer did not provide information about specific service lines.
5. In the lower right, click the Save Adjudication button.

Add Provider-Level Adjustments

If the remit includes any adjustments that don't apply to a specific claim, you can add them as provider-level adjustments to offset the remaining payment amount.

1. From the list of claims linked to a remit, click the Provider-Level Adjustments tab.
   
    
2. In the lower right, click the + Adjustment button.
3. Fill in information about the adjustment.

   Date	The date of the adjustment.
   Amount	The adjustment amount.
   Code	The reason code provided for the adjustment. Click the reason codes icon to view a list of typical codes.
   Reference	The adjustment's reference number.

4. Click the Save Adjustment button.

Finalize Claims from the Remit

Once a claim's adjudication information has been added to a remit, you can finalize the claim to the next payer or to the patient's billing account. The Next Step column indicates which of these will happen when you finalize each claim.

• Finalizing to the next payer creates a new instance of the claim that can be sent to the payer.
• Finalizing to a billing account adds the total of any Patient Responsibility adjustments to the account's statement as a charge.

To finalize the claims on a remit:

1. From the list of claims linked to a remit, select the checkbox next to one or more claims.
   
    
2. In the lower right, click the Finalize button.
3. To confirm that you want to finalize the selected claims, click the Finalize Adjudications button.
   

    NOTE:  If a claim has a red icon  next to it, then too much or not enough of the submitted charges have been allocated on remits. You'll need to balance the claim before it can be finalized.

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