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Overview

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Info

The Payment page opens from the Payment Batch page based on the type of payment added to the payment batch. The fields and information on the Payment page vary based on the type of payment. The types of payment include:

Use the Insurance Payment page to record validation controls for a check being applied to an insurance balance.


Info
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titleHow to Get Here?

To open the Payment: New page for new insurance payment:

From the Home Page:From the Menus:Via Shortcut Keys:
  1. Click Payment Batches from the Manage list.
  2. Search and select the payment batch to view.
  3. Double-click a payment batch to open the Payment Batch: [ID] page.
  4. Click Create Ins.
  1. Open the Manage menu and select Payment Batches.
  2. Search and select the payment batch to view.
  3. Double-click a payment batch to open the Payment Batch: [ID] page.
  4. Click Create Ins.
  1. Press [Alt] + [M] + [P].
  2. Search and select the payment batch to view.
  3. Press [Alt] + [U] to open the Payment Batch: [ID] page.
  4. Press [Alt] + [I].

To open the Payment [ID] page for existing insurance payment:

From the Home Page:From the Menus:Via Shortcut Keys:
  1. Click Payment Batches from the Manage list.
  2. Search and select the payment batch to view.
  3. Double-click a payment batch to open the Payment Batch: [ID] page.
  4. Select the payment to be viewed/modified.
  5. Click Update.
  1. Open the Manage menu and select Payment Batches.
  2. Search and select the payment batch to view.
  3. Double-click a payment batch to open the Payment Batch: [ID] page.
  4. Select the payment to be viewed/modified.
  5. Click Update.
  1. Press [Alt] + [M] + [P].
  2. Search and select the payment batch to view.
  3. Press [Alt] + [U] to open the Payment Batch: [ID] page.
  4. Select the payment to be viewed/modified.
  5. Press [Alt] + [U].



 

(Click an image below to enlarge.)

Payment: New / Suspense Tab

Payment: New / Recoup Tab

Payment: New / Misc Income Tab

Payment: [ID] Page 

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Field Definitions

Field

Type

Required

Description

Check Information Section


Image SetDrop DownNoThe image set from the payment batch to attach to this payment. Click View to preview the images in the set.
Transaction TypeDrop DownNo

The type of transaction used for the payment, e.g., Check, ERA, Credit, EFT, Lockbox.

Note
If the insurance payment is generated because of an ERA import, the field will default to ERA.


Number

Free Text

(numeric)

YesThe check number issued by the payer.
Amount

Free Text

(numeric)

YesThe amount of the check remitted for the claim.
Date

Calendar Date

(mm/dd/yyyy)

YesThe date of the check issued by the payer.
Accounting Date

Calendar Date

(mm/dd/yyyy)

YesThe accounting date for this payment.
PayerDrop DownYesThe payer that issued the check.
PlanDrop DownNoThe plan that belongs to the payer.
Balance Information Section

Information about the currently applied distribution. These amounts are dynamically updated as distributions are applied.  
Total Recouped

Read-only

(system-calculated)

YesThe sum total of all recoups processed from the check.
Applied from Check

Read-only

(system-calculated)

YesThe total amount applied from the check, including the sum of payments and recoups.
Remaining for Application

Read-only

(system-calculated)

Yes

The difference between the total amount of the payment and the amount of funds currently distributed from the payment. If all funds have been distributed, this value is zero (0), meaning the payment is in balance and can be posted. In some cases, Remaining for Application could actually be a negative value for a period of time.

If a value has not been specified in the Number box, this value will be pending.

Recoups increase the total Remaining for Application.

Check Balanced

Read-only

(system-calculated)

Yes

Indicates whether the Remaining for Application equals the total check amount values.

  • Yes indicates all funds have been distributed and Remaining for Application has a zero (0) value.
  • No indicates that not all funds have been distributed and Remaining for Application contains a value other than zero (0).

This value updates when the value of Remaining for Application changes.

Suspense Tab

This tab displays transactions applied from a check remitted by a payer that have been transferred to Suspense.
Description

Display Only

(system-generated)

YesThe transaction that has been transferred to Suspense. This text includes the payment identification number and reason entered in the Note option on the Payment Transfer to Suspense window: Transfer from payment: [ID]:[note], for example, Transfer from payment: 312:Overpayment.
Amount

Display Only

(pulled from Suspense transaction)

YesThe payment amount being transferred to Suspense. This amount is specified on the Payment Transfer to Suspense window.
Type

Display Only

(pulled from Suspense transaction)

No

The sub-type that identifies why the monies are being transferred to Suspense. Select one of the following codes to indicate the reason for transfer to Suspense.

  • [blank] - Subtype is not being used
  • OTHER - Other reason
  • OVERP - Overpayment
  • UNKNWN - Unknown source/cannot identify
Created

Display Only

(system-generated)

YesThe date and time (yyyy-mm-dd hh:mm:ss) when the transaction was created. This information is updated after the payment is saved.
Recoup Tab

This tab displays transactions that have been added for recouping insurance monies that have been applied to a guarantor account, Suspense, or miscellaneous income.
Description

Display Only

(system-generated)

Yes

The transaction that has been rescinded from a guarantor account, Suspense, or miscellaneous income. This text includes the payment identification number to which the payment is being applied and reason that was entered in the Note option on the Recoup window: Rescinded to payment: [ID]:[note], for example, Rescinded to payment: 312:Overpayment.

Amount

Display Only

(pulled from Recoup transaction)

YesThe payment amount being distributed from a rescinded payment from either a guarantor account, Suspense, or miscellaneous income. This amount is specified on the Recoup window.
Type

Display Only

(pulled from Recoup transaction)

YesIndicates if the monies were rescinded from a guarantor account (ACCT), Suspense (GSUSP), or miscellaneous income (MISC).
Created

Display Only

(system-generated)

YesThe date and time (yyyy-mm-dd hh:mm:ss) when the transaction was created. This information is updated after the payment is saved.
Misc Income Tab

This tab includes payments distributed directly to miscellaneous income.
Description

Display Only

(pulled from Payment Transfer to Misc Income transaction)

YesIncludes the text entered into the Note field of the Payment Transfer to Misc Income. Use this window to enter the explanation of why the amount is being transferred to Miscellaneous Income.
Amount

Display Only

(pulled from Payment Transfer to Misc Income transaction)

YesThe amount distributed to miscellaneous income. This amount will appear in the Misc Income column on the Payment: [ID] page after the distribution is saved on the Add Distribution window.
Created

Display Only

(system-generated)

YesThe date and time (yyyy-mm-dd hh:mm:ss) when the transaction was created. This information is updated after the payment is saved.
Service Lines Tab

This tab contains the list of distributions that have been entered for the insurance payment. 
Claim

Display Only

(pulled from Service Line)

YesThe unique identification number assigned to the claim to which the distribution was applied.
Patient

Display Only

(pulled from Service Line)

YesThe name of the patient to which the payment is associated.
Rank

Display Only

(pulled from Service Line)

YesThe rank position the payer of the distribution has on the related account.
Network Status

Display Only

(pulled from Service Line)

Yes

Provides quick identification as to whether a claim is in or out-of-network.

  • If Out-of-Network, the text will display in red.
Note

It uses Date of Service + Plan-Practice Network Status + Contract Effective Date to determine.

  • Ex. Date of Service = 04/02/2022, Network Status = In-Network, Contract Eff. Date = 04/01/2022 – IN NETWORK
  • Ex. Date of Service = 03/01/2022, Network Status = In-Network, Contract Eff. Date = 04/01/2022 - OUT OF NETWORK


Billed

Display Only

(pulled from Service Line)

YesThe amount billed for the procedure.
Expected

Display Only

(pulled from Service Line)

YesThe amount of reimbursement expected from the payer or plan for the services rendered. This amount is calculated by the applicable expected fee schedule.
Balance

Display Only

(pulled from Service Line)

YesThe amount of the current balance on the procedure.
Allowed

Display Only

(pulled from Service Line)

YesThe amount the payer will reimburse for the procedure.
Disallowed

Display Only

(pulled from Service Line)

NoThe amount specified as the difference between the billed amount and the allowed amount the payer will reimburse.
Cont WO

Display Only

(pulled from Service Line)

YesThe calculated amount to be written off due to the contractual agreement between the practice and the primary payer. Contractual write-offs pertain only to the primary payer on the claim. The contractual write-off amount is the difference of the billed amount and the allow amount (Billed – Allow = Cont WO). By default, this space is blank and locked until the Allow amount is specified.
Deduct

Display Only

(pulled from Service Line)

YesThe amount the insured is responsible to pay before the payer is responsible for reimbursement.
Copay

Display Only

(pulled from Service Line)

YesThe amount of the service that was indicated as the responsibility of the insured.
Payment

Display Only

(pulled from Service Line)

YesThe amount of the distribution to be applied toward the service line. By default, this column is blank. Type the payment amount in the space provided. This amount will be recorded as the GPYMT activity code in active AR.
Reason

Display Only

(pulled from Service Line)

YesThe CSMA code associated with the group code, indicating the reason the claim is being adjusted by the payer. This information communicates to the guarantor the reason the claim was not paid as it was billed. If the claim is being adjusted, the reason code is provided on the EOB or remittance advice. By default, this option is blank. After specifying the group code, click the appropriate reason code from the list. Based on this selection, the appropriate description for the reason code will appear in the Description column.
Adjust

Display Only

(pulled from Service Line)

NoThe amount applied as a miscellaneous adjustment (positive or negative) on the service line.
Whold

Display Only

(pulled from Service Line)

Yes

The amount being withheld by the payer on the claim, as indicated on the EOB. Withholding is primarily associated with managed care, such as HMO plans. The plan may stipulate that a certain amount be withheld on a payment, for example, 15 percent, and then refunded to the insured at the end of the year if certain conditions are met. Type the amount from the EOB that is being withheld, if applicable.

This amount will be recorded as the WHOLD activity code in Active AR.

Misc Income

Display Only

(pulled from Service Line)

NoThe amount of the payment distributed to miscellaneous income from the Add Distribution window.
New Balance

Read-only

(system-calculated)

YesThe balance adjusted for the distribution.


Button Descriptions

Button

Shortcut Keys

Description

Step-By-Step Guides

Suspense Tab


View[Alt] + [V]To view the transaction entry on the Suspense page.
  1. From the Payment / Suspense tab, select the transaction to review.
  2. Click View. The Suspense page opens for review.
Add[Alt] + [D]To open the Payment Transfer to Suspense window, where you can specify the amount and reason the payment is being transferred to Suspense.Transferring Payments to Suspense
Remove[Alt] + [R]To remove the transaction entry from the Transfer to Suspense table.
  1. From the Payment / Suspense tab, select the transaction to remove.
  2. Click Remove. The transaction is removed from the Suspense tab and from the Suspense page.
Recoup Tab


View[Alt] + [I]

To view the transaction entry (RSCND) that was added to recoup the payment, which can be rescinded from a guarantor account, Suspense, or miscellaneous income.

  1. From the Payment / Recoup tab, select the transaction to review.
  2. Click View. The following occurs:
    • If the transaction is for a payment recouped from an IPYMT on a guarantor account, the Active AR tab for that guarantor account appears.
    • If the transaction is for a payment recouped from Suspense, the Suspense page appears.
    • If the transaction is for a payment recouped from miscellaneous income, the Misc Income page appears.
  3. Review the line item entry for RSCND to see the rescinded payment transaction.
Recoup[Alt] + [E]To open the Recoup window to specify where the money is being rescinded from, the amount, and additional information related to the transaction.Applying Rescinded Payments
Remove[Alt] + [O]To remove the transaction entry from the Recoup table.
  1. From the Payment / Recoup tab, select the transaction to remove.
  2. Click Remove. The transaction is removed from the Recoup table, as well as the page or tab from which the payment was rescinded: Active AR tab, Suspense page, or Misc Income page.
Misc Income Tab


Add[Alt] + [D]To open the Payment Transfer to Misc Income window where you can specify the amount and reason the payment is being transferred to miscellaneous income.

Transferring Money to Miscellaneous Income


Remove[Alt] + [R]To remove the transaction entry from the Misc Income table.
  1. From the Payment / Misc Income tab, select the transaction to remove.
  2. Click Remove. The transaction is removed from the Misc Income table and the Misc Income page.
Service Lines Tab


Add Next[Alt] + [N]To add a service line distribution for an insurance payment.Adding Service Line Distributions (Insurance Payment)
Update[Alt] + [U]To modify an unposted, service line distribution from an insurance payment.Updating Service Line Distributions
Remove[Alt] + [R]To delete a service line distribution that has been entered, but not posted, on an insurance payment
  1. From the Payment / Service Lines tab, select the service line distribution to delete.
  2. Click Remove. The service line is deleted and the Balance Information section is updated with the adjustment.