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Training. Remittance Posting. Overview. Designed to take all the information on an EOB (Explanation of Benefits) or ERA (Electronic Remittance Advice) and use it in a grid –based form. Concept. Centered around an ERA or EOB. What is an ERA?.

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Training

Training

Remittance Posting


Overview

Overview

Designed to take all the information on an EOB (Explanation of Benefits) or ERA (Electronic Remittance Advice) and use it in a grid –based form.


Concept

Concept

Centered around an ERA or EOB

  • What is an ERA?

  • Electronic Remittance Advice – File downloaded from clearing house

  • What is an EOB?

  • Explanation of Benefits – Mailed to clinic

  • What does it look like? (Next Slide)

  • How it works

    • All claims on one form

    • All detail from the same grid

    • The grid won’t let you apply a batch until it balances


Sample eob

Sample EOB


Remittance posting grid

Remittance Posting Grid

  • Accessing Remittance Posting from Application Button

  • Billing Menu, Remittance Posting

  • Insurance Menu, Remittance Posting

  • Quick Launch, Remittance Posting


Anatomy of the form

Anatomy of the Form

The Remittance Grid

Header Information

Related to Green area on sample EOB image

Carrier Information

Check Information

Claims Information

Related to Orange area on sample EOB image

Individual Claim Charges

Related to Blue area on sample EOB image

Write-Off / EOB Reasons sub-grids

Totals Row


Anatomy of the form1

Anatomy of the Form

Actions

Apply

Posts batch

Creates transactions

Open / Pause Batch

Can review completed batches, but cannot change them

Can delete unapplied batches

Recode CPT

Uncommon. Accounts for insurance recodes, bundles, and unbundles.

Assign Allowed Values

Should be done before batch is applied

Clear Form

Does not affect transactions

View 835 Files

Electronic remittance


Posting a remittance batch

Posting a Remittance Batch

Heading Information

Check Information

Posting Date

Payment type

Only used within PS X10, so there is no associated value on the EOB / ERA

Carrier Information

Managing Claims within the Grid

Adding a new claim

Will receive warning if claim is associated with a different carrier

Searching for an existing claim

Removing a claim from the grid


Posting a remittance batch1

Posting a Remittance Batch

Claim with a Single Charge

Allowed

Automatically calculates the adjust amount.

Adjust can be used to calculate allowed instead.

Does not create a transaction. A write-off or other type of entry must be created.

Paid

W/O (write-off)

Accounts for adjust amount. A transaction will be created for the write-off.

Write-off grid designed for speedy entry.

Don’t have to search for known codes

Amount automatically filled

Enter or Tab can be used to progress through fields

EOB (EOB reasons)

Right click on field to select MRU. EOB combinations included in MRU.

Right click within grid to create new EOB reason.

Resp for Remaining

Network Status

Responsible Party


Posting a remittance batch2

Posting a Remittance Batch

Claim with Unpaid Deductible

Allowed

Paid

Insurance not paying for anything since deductible not yet met

Still requires $0.00 balance.

Blank Paid amounts will not generate transaction records.

W/O

ERA / EOB

PR-1 – Deductible not yet met.

PR-2 – Co-Insurance

PR-3 – Co-Pay

CO-45 – Contract Obligation

Applied Deduct (applied deductible)

Full amount of charge

Resp for Remaining

Patient responsible for full amount

Remain

Shows that patient portion is not yet paid.


Posting a remittance batch3

Posting a Remittance Batch

Claim with Secondary Insurance

Allowed

Paid

W/O

Accounts for Allowed amount discrepancy

EOB

Two reasons for discrepancy between Paid and Billed

Lower allowed amount

Unpaid Co-Pay

Resp for Remaining

Secondary insurance is responsible for the remaining amount.

Remain

Shows that insurance portion is not yet paid.


Using actions

Using Actions

Apply - Posts validated payments, write-offs, EOB reasons, and deductibles. Validations are as follows:

When a Payment Amount of greater than $0.00 is entered, the Check Number must be supplied.

The Balance field of the claims grid must be $0.00 before the batch can be posted.

You must specify a Payment Type for the batch. 

The batch must contain at least 1 claim.

You will receive a warning for claims where a service line within the batch has a negative balance or a warning if an unapplied credit currently exists on a patient's account.

Pause Batch – Suspends batch for later entry.

Recode CPT – Used to account for recodes, bundles, and unbundles.

Assign Allowed Values – Used in future postings to predict expected payments.

Must be used before batch is applied.

Valid for specified time period. Insurance carrier specific. Doctor specific by default.

Clear Form – Clears all data from heading and grid.

View 835 Files – Used in electronic remittance.


Electronic remittance

Electronic Remittance

Overview

How it works

Retrieve X12 file

Place in Inbox

Review and post Electronic Batch

Configuring Inbox Location

Server console

Path

Must be UNC (Universal Naming Convention)

File pattern


Electronic remittance1

Electronic Remittance

Posting Electronic Batch

Retrieve X12 File

Copy from FTP or Web

Place in Inbox

Automatically picked up

Review electronic batch

Grid layout and function identical to manual batch

Fill out Payment Type

Confirm details

Apply batch


Electronic remittance2

Electronic Remittance

835 Viewer

Entire 835 file stored in SQL

Date Range

Reprocessing batches

Won’t let you unless batch is erroneous

Duplicates existing batch

Remove

Removes SQL source record

Breaks auditing trail

View details

View raw 835 file

Email to M4 Support


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