5.1 Posting Insurance EOB Checks

5.1 Posting Insurance EOB Checks

Below are instructions for posting an EOB Insurance payment.
 
Go To: BILLING > CLAIMS CENTER> EOB-Payments

1. Click Enter New EOB

   1. Enter Payment Type [Check, Credit Card (Manual), or Credit Card (OpenEdge)]

      1. If Credit Card (Manual), enter in: Card Number (last 6 digits), Card Type, Expiration Date, (Optional) Check/EOB Number, Insurance, Date of Check, Post Date and Amount

      2. If Check enter in: Check number, insurance, date on check, post date, amount

      3. If Credit Card (OpenEdge)*, enter in: Zip code found on virtual credit card, Check/EOB Number, Insurance, Date of EOB, Post Date, and Amount'

   2. Click Post (Reset to clear or Cancel)

      • Click "Save/Post Later" if you're posting at a later time. The check will save in the table below

        • Click on the open check from the table to open up the details and post when you are ready

   3. If using the Credit Card (OpenEdge) option, click ‘Make Payment & Post’. This will bring up a pop up window for you to enter in the credit card number, expiry month, expiry year, and CVV. You will then scroll down and click ‘Make Payment' to process the transaction.

      1. Clicking ‘Make Payment & Post Later’, will bring up the window above to process payment but the check itself will be in the table below to post to patient’s accounts at a later time.

2. Search Claims

   1. Click in the search bar to start searching for your patient by name

      1. You can also use the Advanced search to search by claim number, date of service, open/closed claims or adding a facility payment

3. Procedure Details

   1. Allowed: Enter the amount appearing on your EOB that the insurance company has showing for each CPT line item (Alternatively, you can enter the full 'Billable' amount if you'd like the entire pending balance to pull forward)

   2. Payment: Enter the payment amount for each CPT line item.

   3. Adjust Amount:  The difference between the Allowed amount and Paid amount will auto-calculate and show in this column

   4. Adjustment Type: Click on the dropdown to identify a reason for adjustments.

   5. Under Trans ($)  the system will automatically calculate the difference between the billable & allowable/adjusted amounts, & any balance being forwarded to the next responsible party.

   6. Resp. Party: Depending on how the charges were originally filed, this is where the next responsible party will appear. 'Patient' indicates that the balance will be forwarded to patient responsibility.

   7. DOS: Clicking on 'DOS' allows you to view Encounter Details on the patients account.

   8. Click on Apply Payment once you are done entering all details.

   9. Optional- Add Facility Payment- See instructions below

   10. Remaining Balance: Under Check Details should show a $0.00 balance indicating that the entire check amount has been posted.

   11. Click Close Check to close the check. You must close checks to complete the payment posting process & for balances to fully transfer to the next responsible party.

ADDING A FACILITY PAYMENT
At times, the facility may receive an incentive payment that is not allotted to a certain patient.  These can be added by:

• Clicking on the advanced search and selecting Add Facility Payment

• Enter amount and if needed a note

• Click Save

 
Click Close Check to close the check. You must close checks to complete the payment posting process & for balances to fully transfer to the next responsible party.
 
Posting Payments To Multiple Patients
Once you apply your payment to the first patient & click 'Apply Payment' you will repeat Steps 2 & 3 for each individual patient.
You do have the option to leave Insurance EOB checks open for further management. However, ultimately all checks must be closed in order for balances to fully transfer to next responsible party.

Writing off the transfer amount

• After the payment is applied, in the Check Payment Summary you can click on the $ in the transfer amount

• Enter in the Write Off Amount, Select Reason, Save

Editing the check details before closing

• If you realize you made a mistake when entering the check details or perhaps some of the payments do not belong in ChiroFusion, you have the ability to edit the check by clicking on the pencil icon next to the EOB/Check Number

• If you are utilizing the Credit Card (OpenEdge) option, you will only be able to edit the Check/EOB Number, Date, and Post Date. Users cannot edit the check amount once the payment has been processed.

Adding Primary details to send to secondary

If you are posting a check manually and need to send to the secondary, you must reflect what the primary insurance did.

• After searching a patient and entering in the allowed and payment amounts, you will need to click on the claim number for EACH CPT code.

  • This will allow you to enter in Line Adjustments. Usually there is a CO Amount (normal codes or reasons for this include 45) and then in the amount you will enter in the Adjustment amount

  • There should also be a PR Amount (usually the codes are 1, 2 or 3) and you will enter in the transfer balance.

  • Note: If the amount listed in the Adjustment or Transfer Balance field is 0 you do not need to include it in the line item adjustments.

• Once this is done you will click save.

• Again, remember to do this for each code.

Closing Check

• If the check is going to the patient no screen will pop up

• If the insurance is the next responsible party you will receive a pop up asking if you want to mark the secondary in a filed status

  • Confirm- Will simply mark them as filed. This will NOT send out the claims to a secondary.

  • Cancel- This will generate a claim for you for the secondary insurance in your print/send claims screen.

To manage open checks

• All checks should be closed after payment has been applied. This finalizes the payment process. If checks are left open or saved to post alter, they will be visible on the EOB Posting page where users can click on the check number to open the check and finish.

To view Details

• Click on the patient’s name to view their Demographic information

• Click on the DOS to view the encounter details