Manual Insurance Payments

When you need to manually remit a claim you can search by payer and service date and then add payment type, check number, check dates, and notes to the claim remitted manually.

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Manual Payments

1. Click Billing on the navigation bar and Manual Insurance Payments.
2. Select the Payer.
3. Enter the date or date range of service.
4. Click Search Unpaid Claims.
    

   

   
    
5. Enter payment information: Payment Type, Total Amount of Payment, Payment Number and Payment Date.

   

6. Select the service line(s).

   

7. Use the column headings to view breakdown of results:
   Client, Date(s) Services, Billed Amount, Insurance Amount Due, Paid Amount, Adjustment Type, Group Code, Reason Code, Adjustment Amount, Write Off, Shift to Client, Actions.

   

8. Enter Paid Amount.
9. Enter Adjustment Type, Group Code & Reason Code as needed.

   NOTE: Amounts for eligible adjustment types (for example, deductible) will move to the Shift to Client column.

   CO-45s & CO-253s will shift to the Write-Off column. PR-1s, PR-2s & PR-3s will shift to the Shift to Client column.

   

    

10. You will get validation warnings or errors if there are discrepancies between expected and actual Paid Amount, Shift to Client & Write-Off amounts.
    • Hover over red icon to see the warning message:
      Paid amount and write-off amounts exceed the total amount due for the line and cannot be applied. Please modify these amounts before continuing.
       

      

       

    • Hover over yellow icon to see the warning message:
      Paid amount and write-off amounts exceed the insurance amount due. The client amount due will be updated in order to apply this insurance payment and write-off.
       

      

       

11. Click Apply Payment for the claim(s).
12.  Confirm or cancel Apply Payment.

    

     

13. Upon posting, the following actions will occur:
    • Paid Amounts will be created as payments
    • Adjustment Amounts will be created as adjustments with the appropriate code
    • Write-Off Amounts will be created as write-offs
    • Shift to Client Amounts will be shifted from Insurance Due to Client Due, as long as the money is available to shift

Denied Payments

1. Apply a zero-dollar payment.
2. Enter Adjustment Amount.
3. Use the Denied toggle to mark the payment as denied. 

    NOTE:  This amount will not shift to the client.

4. Click Apply Payment.
5. Confirm Apply Payment.

   

6. Click Claims in the side navigation panel.
7. The claim will show as Rejected/Denied.

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