Payment Posting Primary, Secondary and Beyond. LeeAnn Pavlick RCM Consultant. Agenda. Setup Requirements for Posting Insurance Carrier Transaction Column Set(s) Adjustment & Payment Types Insurance Group(s) Payer Literal(s) Override Standard Payer Name Posting Primary Insurance Payment
Must assign a Transaction Column Set to every Insurance Carrier
Error Message when Transaction Column Set no Assigned
Ability to assign specific Payment Types, Adjustment Types, Transfer notes
Amounts populated in Actual Allowed automatically populate in the Contractual Adjustment
Amounts populated in Contractual Adjustment automatically populate in the
Specific Payment Types can be assigned to each of the Transaction Column Sets (Breaks out each on Daily Transaction Reports)
Determines during Electronic Remittance Posting if balance on Line Item should be adjusted, transferred, split or no action
Check in this column determines if a specific procedure will appear in the Claim File or
Hard Copy Claim
Ability to complete the adjudication information at line level (Such as the Contractual-CO45 & Patient Responsibility (PR-1,2,3)
tracking Bad Debt
tracking sequestration adj
tracking PLB adj
for NSF checks
Daily & Monthly Transaction
Daily & Monthly Financial
Ability to link carriers together that appear in same Electronic Remittance File or on the same paper EOB.
Ability to link carriers together that use the same ID numbers or filing requirements.
Ability to link carriers together that need to use the same Fee Schedules.
Additional setup required for Electronic Remittance
-Found in Actual 835 Remittance Files
- Must be entered on all Carriers included on EOB
Used when there are multiple instances of the same payer with different names to define the different plans
transaction amounts will be
applied to Insurance balance
Financial period where transactions will appear
Insurance Group vs Insurance Carrier
If multiple payers appear on the same paper EOB
- If Date of Entry is different than actual deposit date
- Searchable in Transaction Management
- Used in Deposit Slip & Daily Balance Reports
- Total of Check or EFT to be deposited in the bank
- All transactions in Check Remittance should balance to this amount
- Check used for either Check or EFT
- Required for Electronic secondary
Actual Allowed -
Auto populates the Contractual Adjustment
Enter Amount paid, if zero (0.00) always enter in 0.00
Amount to be transferred to the Patient Balance
Transfer Notes -
Pull Down for Quick Notes or Free Text
Line Information –
Report Contractual and Patient Responsibility Codes from EOB (CO, PR, OA) for Electronic secondary
Code Qualifier -
HC for UB or CMS1500 / Medical
AD for ADA / Dental
Adjudication Date -
Date of remittance / check
Code / Modifiers -
CPT codes paid
Group Codes –
CO – Contractual
PR – Patient Responsibility
OA – Other Adjustment
Reason Codes –
45 Contractual adjust by carrier
253 sequestration adj –Medicare
2 Co Insurance
Most frequent error in Electronic secondary claims is balancing.
Each Line filed to secondary should balance
Payment + Contractual Adjustment + Patient Responsibility = Fee
60.00 + 5.00 + 10.00 = 75.00
Payer Paid Amount only for those procedures selected as “File to Insurance” . If utilizing the GE Centricity File creator for 2nd claims the Remaining Patient Liability is also required.
The Asterisk next to the carrier name indicates the carrier that the visit is currently assigned.
Visit Status – normally File Succeeded if electronically filed.
Moves visit to In-Progress Secondary for approval & batching
Moves visit to Filed Secondary when Primary has sent crossover
Uncheck the “File Next” box and click OK.
Visit will move to “Paid” or “Waiting Patient Payment” if there is a balance still owed by the patient.
Before clicking OK – change visit status to “File Rejected” if additional follow-up is required.
Also add the ICN from the primary payer
Uncheck the “File Next” box and click “Cancel”.
Visit will now be in “File Rejected Primary”
Interest payment is added to visit /ticket with $0.00 charge
Payment and adjustment are then posted to Interest procedure
Will not be reflected in claims sent to secondary payer.
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