Permissions Required: Clinic Staff must have Administrator, Billing Manager, Billing Assistant, or Operations Manager Permissions assigned in order to manage 835 Postings.
Applying an 835
Once the 835 has a payment associated with it, it is time for application. Selecting Post Claims from the right-click menu displays the 835 Claim screen.
The screen is divided into 3 sections. The top section is the 835 Information panel and looks as follows:
This section describes the details of the 835 that is currently being worked.
Claim Fields
| Check Amount | The total amount represented in the EOB. |
| Check/EFT # | Check / EFT # as reported in the 835. |
| Check/EFT Date | Check / EFT Date as reported in the 835. |
| Handling Code | Handling code as reported by the carrier in the 835. |
| Payment Code | Additional information codes reported in the 835 by the carrier. |
| Receiver ID | ID code reported in the 835 by the carrier. May be required in communicating back with the carrier about the given carrier. |
| PLB Amount | Policy Level Adjustment reported in the 835. |
The second section is the claim list and is found on the left side of the dialog.
This list contains 4 columns and is defined as follows:
Claim List Columns
| Status Icon | Displays the current status of the individual claim. |
| Page No | If the 835 was printed, this number would correspond to the page number where the claim would be found. |
| Patients Last Name | Last name of the patient identified in the claim. |
| Amount | Amount of money from the associated payment that will be posted to this claim. |
The Status Icon can take on 1 of the following 5 values:
835 Status Icons
| The claim is ready and able to be auto-posted. | |
| Claim HAS been auto-posted. | |
| The claim has been manually taken care of and marked as complete. | |
| The claim is not postable. | |
| A non postable claim has been acknowledged by the user. | |
| The claim has been denied by the carrier. These claims can be manually posted; the invoice state will not be affected. |
At the bottom of the claim list is the status of the currently selected visit.
Selecting a claim in the list will display the claim information in the claim information panel on the right side of the dialog. As shown below:
This format should look very familiar to you as it reads very much like a standard paper EOB. The header contains the following information:
Claim Header Fields
| Claim Status | Status of the claim as reported by the carrier. |
| Claim ID | Claim ID as assigned by Fusion Enterprise when the claim was sent. |
| Patient ID | Patient ID as reported back from the carrier. Is equivalent to the Insured ID in the policy. |
| Payer Control | Control number assigned by the carrier. |
| Remark Codes | Remark codes returned by the carrier. A key explaining the remarks is found in the code glossary at the bottom of the claim. |
| XO Carrier | If Medicare does a crossover to secondary, the crossover carrier will be listed here. |
| XO Carrier ID | If Medicare does a crossover to secondary, the crossover ID will be listed here. |
| Claim Adjustments | If any claim level adjustments were made then they will be displayed to the right of the claim header in bright orange text (not shown). |
Under the header is the actual claim with the following columns:
Claim Columns
| Visit | Date of service of the claim. |
| Units charged, units paid | Claim ID as assigned by Fusion Enterprise when the claim was sent. |
| Billed Amount | Amount billed in the original claim. |
| Paid | Amount paid for the line item. |
| Code | Reason code for the adjustment. |
| Adjustment Amount | Amount of adjustment. |
| Contract | The amount specified in Fusion Enterprise contract manager for this particular carrier and charge code. |
After selecting a claim, the right-click menu will display the following options:
Claim Header Fields
| Post | Auto posts the selected claim. |
| Manual Post | Displays the EOB Posting dialog and allows you to manually post the claim. This is the same dialog as is used in the regular posting dialog. |
| Post All | Posts ALL claims in the 835 that are postable. |
| Mark Complete | Marks the claim as complete. This indicates that you have handled this claim elsewhere and no longer want to deal with it in this dialog. |
| Set Invoice State | Allows you to change the invoice state for the visit represented in the claim. |
| Open Case | Opens the case dialog for the case. |
| Open Transactions | Opens the transactions dialog for the case. |
| Billing Note | Opens the billing note for the case. |
| Case Note | Opens the case note for the case. |
| View Payment | Displays a report showing everywhere the current payment has been posted. |
| Print EOB | Prints out the current page of the EOB. The entire EOB may be printed from the previous screen. |