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Overview

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Info

The Distribution: [ID] page is used to record the disbursements on service lines of a claim.

Tip
Use the Explanation of Benefits (EOB) from the payer to complete the service line distribution.



Info
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titleHow to Get Here?

To open the Distribution: [ID] 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 the payment batch. The Payment Batch: [ID] page opens.
  4. Click Create Ins. The Payment: New page opens.
  5. Enter the information in the Check Information section.
  6. Click Add Next in the Service Lines section.
  1. Open the Manage menu and select Payment Batches.
  2. Search and select the payment batch to view.
  3. Double-click the payment batch. The Payment Batch: [ID] page opens.
  4. Click Create Ins. The Payment: New page opens.
  5. Enter the information in the Check Information section.
  6. Click Add Next in the Service Lines section.
  1. Press [Alt] + [M] + [P].
  2. Search and select the payment batch to view.
  3. Press [Alt] + [U]. The Payment Batch: [ID] page opens.
  4. Press [Alt] + [I]. The Payment: New page opens.
  5. Enter the information in the Check Information section.
  6. Press [Alt] + [N].

To open the Distribution: [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 the payment batch. The Payment Batch: [ID] page opens.
  4. Select the payment to modify.
  5. Click Add Next in the Service Lines section.
  1. Open the Manage menu and select Payment Batches.
  2. Search and select the payment batch to view.
  3. Double-click the payment batch. The Payment Batch: [ID] page opens.
  4. Select the payment to modify.
  5. Click Add Next in the Service Lines section.
  1. Press [Alt] + [M] + [P].
  2. Search and select the payment batch to view.
  3. Press [Alt] + [U]. The Payment Batch: [ID] page opens.
  4. Select the payment to modify.
  5. Press [Alt] + [N].



 

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Field Definitions

The expected fee schedule applied to the payment. This field can be overridden with another active fee schedule associated with the practice listed in the drop down.

Field

Type

Required

Description

Claim Information Section

Identifies the claim to which the payment is being applied. Most of the information shown in this area is static and pertains to the claim that was submitted.

Claim IDFree Text / SearchYes

The identification number assigned to the claim when it was generated.

  • To enter a service line distribution, enter the claim number in the Claim ID field, or click Image Modifiedto open the Find Claim window. Upon specifying the claim number, all other information in the Claim Information section is automatically filled in with the pertinent information from the case.

  • To update a service line distribution, this field contains the claim number specified when the distribution was originated.

  • To view the claim's raw data after the Claim ID is specified, clickImage Modified. A preview window opens displaying the raw EDI data.

Note
If you enter a claim number incorrectly, the following message appears: Search found no records. Click OK to close the message and return to the Claim field. Enter the correct claim number.


Note
You cannot distribute funds to a service line more than once. If funds have already been distributed to all service lines on the claim, the following message appears: Payment has been distributed to all service lines in this claim. No further distributions are possible. Click OK to close the message and return to the Claim field. Enter the correct claim number.


Note

If you start distributing funds on a claim, and then change the claim number, all distribution amounts entered will be cleared. The following message appears:

Selecting a different claim will clear any distribution information you have entered. Are you sure you want to change claims?  

Click Yes to continue.

Click No to cancel the action and return to the Add Service Line Distribution window.

This item will be recorded as CLAIM in Active AR.

Payment RankDrop DownYes

The rank of the payer when there is one or more payers on the case. By default, this option is set to the primary payer. If the case has multiple payers, you can specify the rank of the payer to which a payment is being applied. 

Control NumberFree TextNoThe unique identification number issued by a payer that identifies a recorded payment. If the payer issued a control number for the payment, enter the number in the space provided.Expected Fee ScheduleDrop DownNo
Note
This field can also be edited on posted payments.
PatientNetwork Status

Read-only

(pulled from the associated Claim)

YesThe person who was treated on the

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


Patient

Read-only

(pulled from the associated Claim)

YesThe person who was treated on the case. If there is a patient alert, it will appear after the claim number is entered.Account

Read-only

(pulled from the associated Claim)

YesThe name on the guarantor account for which the claim was submitted. This option has a direct link to the guarantor account. To preview account information, click the guarantor name. The Active AR tab on the Act: [ID] page opens.Provider

Read-only

(pulled from the associated Claim)

YesThe person who rendered services to the patientExpected Fee ScheduleDrop DownNo

The expected fee schedule applied to the payment. This field can be overridden with another active fee schedule associated with the practice listed in the drop down.

Note
This field can also be edited on posted payments.


Member ID

Read-only

(pulled from the associated Claim)

YesThe identification number of the person insured by the payer.Case ID

Read-only

(pulled from the associated Claim)

YesThe identification number of the case for which the claim was submitted. This option has a direct link to the case. To preview case information, click the case number. The Case: [ID] page at the Patient, Guarantor & Insurance tab opens in read-only mode.Submitted ToProvider

Read-only

(pulled from the associated Claim)

YesThe payer or plan to which the claim was submitted for reimbursement of chargesperson who rendered services to the patient.Claim Amount

Read-only

(pulled from the associated Claim)

YesThe total amount of the service lines on the claim.Facility

Read-only

(pulled from the associated Claim)

YesThe facility where services were rendered to the patient.Submitted To

Read-only

(pulled from the associated Claim)

YesThe payer or plan to which the claim was submitted for reimbursement of charges.Check Information Section

Displays information about the check that was remitted and the amount distributed from the check and the remaining for distribution. The original information is entered in the Check Information section on the Payment: New or Payment: [ID] page. These values are informational only and used to identify the check that was remitted from the payer.Check Number

Display Only

(pulled from created/updated Payment)

YesThe number of the remitted check.Amount

Display Only

(pulled from created/updated Payment)

YesThe amount of the remitted check.Check Date

Display Only

(pulled from created/updated Payment)

YesThe date on the remitted check.Remitter

Display Only

(pulled from created/updated Payment)

YesThe payer that remitted the check.Distribution Distributed from Check

Display Only

(pulled from created/updated Payment)

YesThe amount distributed to service lines from the check. This value is updated as distributions are applied to service lines.Check Balanced

Display Only

(pulled from created/updated Payment)

Yes

The status that indicates whether the remaining for distribution equals the total check amount values.

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

This value is updated when the value of Remaining for Distribution is updated.

Remaining for Distribution

Display Only

(pulled from created/updated Payment)

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

Link

YesA link that opens the Payment: [ID] page for the payment.Misc Income Table

Displays transactions distributed to miscellaneous income from an insurance payment distribution.Description

Display Only

(pulled from created/updated Payment Transfer to Misc Income)

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

Display Only

(pulled from created/updated Payment Transfer to Misc Income)

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

Display Only

(pulled from created/updated Payment Transfer to Misc Income)

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 Section

A list of all service lines for which the claim was submitted. Payments can be applied to one or more service lines as indicated on the EOB. Code

Read-only

(pulled from the associated Claim)

YesThe procedure code for which services were billed.Provider

Read-only

(pulled from the associated Claim)

YesThe provider name who rendered services.Billed

Read-only

(pulled from the associated Claim)

YesThe amount billed for the procedure.Expected

Read-only

(pulled from the associated Claim)

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

Read-only

(pulled from the Account)

YesThe current balance of the service line.Allow

Free Text

(numeric)

Yes

(if primary payer)

The contractual amount the payer or plan will reimburse for the procedure. This information is required for a primary payer. Enter the amount indicated on the EOB in the space provided. If the payer and plan is the primary payer, the calculated contractual write-off amount will appear in the Cont WO column.

Note
If an amount is entered in this column, the Disallow column is not available. If the allowed amount is not specified, you must specify an amount in the Disallow column.


Disallow

Free Text

(numeric)

Yes

(if Allow not specified)

The difference between the Billed amount and the Allowed amount for which the payer will reimburse.

Note
This information is required if the Allow amount is not specified. When an amount is entered in this column, the Allow column is not available.


Cont WO

Free Text

(numeric)

Yes

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

Override IndicatorDescription
Image Modified

Indicates the field is locked and the calculated contractual write-off amount cannot be overridden or does not apply to the distribution type.

This value is updated whenever the Allow amount is changed.

Click to unlock.

Image Modified

Indicates the field is unlocked and the contractual write-off amount can be overridden.

To unlock the option, click the lock. The X appears on top of the lock, indicating the field is available for data input. Click again to lock the option.

If you enter a value when the option is unlocked, then lock the option, the value you entered is replaced with the calculated value.


Deduct

Free Text

(numeric)

Yes

(for Coordination of Benefits with secondary payer)

The fee amount the insured is responsible to pay before the payer is responsible for reimbursement. The deductible amount has no impact on the account balance and is recorded for informational purposes only. This dollar amount is reported by the payer on the EOB.  The deductible information is required on the claim for Coordination of Benefits (COB) with a secondary payer. By default, this column is blank. Type the amount indicated on the EOB as the deductible, if applicable. This value does not impact the service line distribution.

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

Copay

Free Text

(numeric)

Yes

(for Coordination of Benefits with secondary payer)

The fee amount for which the insured is financially responsible. For example, the plan may stipulate that the insured must pay $20.00 for an office visit. The copay amount has no impact on the account balance and is recorded for informational purposes only. This dollar amount is reported by the payer on the EOB. The copay information is required on the claim for Coordination of Benefits (COB) with a secondary payer. By default, this option is blank. Type the amount specified on the EOB as the co-payment amount, if applicable.

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

Payment

Free Text

(numeric)

Yes

The amount being applied as the service line distribution. This amount cannot exceed the Allowed amount.

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

Roll ToDrop DownYes

To specify the next party that is responsible for the account, if the primary payer allows responsibility to roll.

The list of persons or payers that assume financial responsibility on the account after the primary payer has reimbursed on the claim. By default, this option is set to the next party who is financially responsible for paying the outstanding balance on the claim. The options available are based on the rank assigned at the insurance level on the Patient, Guarantor & Insurance tab, for example, 1 = primary, 2 = secondary and 3 = tertiary. If the account has only a primary payer and that payer allows the responsibility to roll to the guarantor, the next responsible party will be set to Guarantor.

OptionDescription

Do Nothing

The financial responsibility does not roll to another party. By default, the Roll To option will be set to Do Nothing if the payer or plan does not allow the responsibility to roll to the guarantor.

Next Plan

The name of the plan next in line in the coverage set, based on the rank assigned at the insurance level. If there is only a primary payer, this option is not shown in the selection list.

By default, the Roll To option will be set to next payer in line if the claim has more than one payer.

Guarantor

The financial responsibility rolls to the guarantor. If the payer or plan does not allow the financial responsibility to roll to the guarantor, this option is not shown in the selection list.

By default, the Roll To option will be set to Guarantor if the payer or plan allows the responsibility to roll to the guarantor.

Write Off Balance

The financial responsibility does not roll to another party. This condition applies when there are multiple payers and plans on the claim and if any of them do not allow the responsibility to roll to the guarantor (Option set in Admin > Payers & Plans > Plan: [ID] > Statements > Statement Options section > Plan allows responsibility to roll to guarantor option). If the service line distribution is entered for the last payer that is financially responsible, the Write Off Balance option is shown in the selection list, indicating that the balance can be written off.

By default, the Roll To option is set to Next Plan if the responsibility does not roll to the guarantor when there are multiple payers or plans on the claim; however, you have the option to select Write Off Balance if you wish to do so.


Note

If the Roll To option is set to None (Write Off Balance), the following confirmation message is displayed when the service line distribution is saved:

The remaining balance cannot be collected from the guarantor because the payer/plan does not allow responsibility to roll to the guarantor. Do you want the system to automatically write off the balance?

  • Click Yes to save the service line distribution and generate a miscellaneous line adjustment for the amount to be written off. This amount is recorded as a miscellaneous negative adjustment in the Active AR with a transaction code of GWOFF and the description of Write-Off - Guarantor Exempt from Payment.
  • Click No to save the service line distribution without generating the miscellaneous line adjustment. The amount is not written off automatically, but must be handled manually.


ReasonPop-up Window (Table)Yes

To specify the group code, reason, quantity (if applicable), and amount the payer has given for not paying the claim as billed.

This window details the reason the claim is being adjusted by the payer. This information is included on the remittance advice or EOB as a means of communicating from one payer to another the reason the claim was not paid as it was billed. Group and reason codes are often referred to as denial codes. For example, PR (Patient Responsibility) is a group code that can have a reason code of 1, indicating that the amount of the adjustment is due to a deductible requirement and therefore the responsibility of the patient.

Image Modified

OptionDescription

Group Code

The code associated to the adjustment that is being applied to the claim by the payer. By default, this option is blank. Click the appropriate group code from the list. The following options are available:

Group CodeDescription
COContractual Write-off
CRCorrection or Reversal
OAOther Adjustment
PEPayer Initiated Reduction
PRPatient Responsibility


Reason

The 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. 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.

Description

The description associated with the reason code.

Quantity

The adjusted quantity of the reason code selected. If you enter 0, a quantity of 1 will be reported. If the quantity entered is more than 1, the quantity entered will be reported.

Amount

The adjustment amount on the claim. Type the amount from the EOB or remittance advice that is being adjusted on the claim. This amount will be recorded as the RCODE activity code in active AR.

Financial Impact

The financial impact the adjustment has on active AR. This value is the adjustment (positive or negative) associated with the group and reason code defined in Denial Management. If the adjustment will affect active AR, click the applicable adjustment code from the This option is primarily used for Electronic Remittance Advice (ERA) processing.


AdjustPop-up Window No

Opens the Adjustment window to specify the purpose and the amount of the miscellaneous adjustment.

Note

The following criteria is necessary in order to open the Adjustment window:

  • The Roll To field is set to roll to Guarantor.
  • The plan has to be one that allows statements. 


Whold

Free Text

(numeric)

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. Enter the amount from the EOB that is being withheld, if applicable.

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

Paid QTY

Free Text

(numeric)

YesThe units or minutes for an anesthesia procedure being applied to the service fee line. This column is primarily used to report to secondary payers for coordination of benefits as to what has been paid and what is remaining on a service fee line for an anesthesia procedure. New Bal

Read-only

(system-calculated)

YesThe balance on the service line after the insurance payment was applied. The difference of Balance and Payment equals the New Balance. If the service line had a credit balance on it prior to entering the distribution, this field will be highlighted in yellow. If the entered distribution results in a service line credit balance, the field will also be highlighted in yellow.CollectionsCheckboxNo

Forces the service line to insurance collections. This checkbox is visible only if the service line is eligible for collections. The service line must meet all of the following conditions:

  • The balance must be greater than zero
  • The responsibility must be payer and not guarantor
  • The service line must not already be in collections

Forcing a service line into insurance collections creates an action called Insurance balance transfer on the account.

Notes Section

Notes on service lines show under the service lines. To record a note on a service line, click the service line.ASA Code

Read-only

(pulled from the associated Claim)

YesThe procedure code to which you are adding notes.DOS

Read-only

(pulled from the associated Claim)

YesThe date the service was rendered.Case Time

Read-only

(pulled from the associated Claim)

YesThe time on the case.Modifiers

Read-only

(pulled from the associated Claim)

YesThe modifiers on the procedure.NotesFree TextYesThe recorded notes.


Button Descriptions

Button

Shortcut Keys

Description

Step-By-Step Guides

Add[Alt] + [A]To open the Payment Transfer to Misc Income window to 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 Distribution: [ID] / Misc Income table, select the transaction to remove.
  2. Click Remove. The transaction is removed from the Misc Income table and the Misc Income page.
Clear Line[Alt] + [L]To clear all data in a service line.
  1. Select a line item from the Service Lines table.
  2. Click Clear Line. All data entered for a service line is cleared.
Edit Notes[Alt] + [N]To record or edit notes on a service line.
  1. Select a line item from the Service Lines table.
  2. Click Edit Notes. The Edit Note window opens.

  3. Enter or update notes in the Notes field.
  4. Click OK. The note is displayed in the Notes section under the Service Lines table.
Link[Alt] + [I]

To link an image specifically related to the service line distribution.

Linking/Unlinking Images to Service Line Distributions

Unlink[Alt] + [U]To unlink an image attached to the service line distribution.Linking/Unlinking Images to Service Line Distributions