Adding Service Line Distributions (Insurance Payment)

Complete this task to add or modify a service line distribution for an insurance payment. This task is a continuation of the Applying Insurance Payments task and begins at the Distribution: [ID] page.

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

Step-By-Step Guide

Step	Instructions	Additional Information
1	From the Distribution: [ID] page of an insurance payment, search or enter the Claim ID. All pertinent information on the Distribution: [ID] page is updated with the claim information.	Finding Claims Click for the Claim ID. The Search Criteria window opens. Do one of the following: To find all claims, click OK. To find specific claims by claim number, enter the Claim ID, and then click OK. To find specific claims by date of service, type or click the DOS, and then click OK. To find specific claims by patient, specify one or more of the following filter options, and then click OK: Patient Provider To find specific claims by payer, specify one or more of the following filter options, and then click OK: Payer Plan When the search is completed, the claims matching the search criteria are listed on the Find Claim window. Use one or more of the filtering controls to find a specific claim in the claim set: Patient Provider Payer Plan As you enter information in the filter, the claims list shows only the claims that match the filter. Clear the filter to display all claims in the claim set. Click the claim to which you are applying the service line distribution, and then click OK. The claim number of the claim you selected appears in the Claim field.
2	(Optional) Open the Payment Rank drop down list and select the appropriate payer from the list.
3	(Optional) Enter the identification number of the payment in the Control Number field.
4	In the Service Lines table, enter the following for each service line on the claim to which the payment is being applied: Enter the amount the primary payer allows or disallows for the procedure, or enter both, in the Allow and/or Disallow fields. The Cont WO field is automatically calculated. Manually update the value, if needed. Enter the amount of the deductible on the EOB in the Deduct field. Enter the amount of the copay on the WOB in the Copay field. Enter the amount being applied to the service line in the Payment
5	Verify the correct party is selected in the Roll To field. If not, open the field drop down list and select the correct option.
6	To specify a denial from the payer, click the Reason field of the service line and enter the following information on the Add Denial Codes window: Enter the Code for new the new adjustment and denial code rule applied. Press the Tab key. The Group Code and Reason Code for the entered code are auto-populated. Enter the units or minutes associated to the anesthesia procedure in the Quantity field, if applicable. Enter the amount of the adjustment to the claim in the Amount field. Open the Financial Impact drop down list and select the adjustment code (positive or negative) if the denial affects active AR. Select the Primary checkbox if the code is the primary one, or the one to take the contractual writeoff on the payment. Click Save to save and to close the Add Denial Codes window.	To open the Add Denial Codes window without using a mouse, tab to the Reason field, and then press the space bar.
7	To specify a miscellaneous adjustment on the service line, click the Adjust field of the service line and enter the following information in the Adjustment window: Open the Purpose drop down list and select the reason for the adjustment. Enter the amount of the miscellaneous adjustment (positive or negative) in the Amount field. Click OK to save and to close the Adjustment window. 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.
8	Enter the amount being withheld by the payer in the Whold field, if applicable.
9	Enter the paid quantity being applied in the Paid QTY field to record the quantity of units or minutes of an anesthesia procedure that is being paid.
10	If the service line had a credit balance on it prior to entering the distribution, the New Balance 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.
11	To force the service line into insurance collections, select the Collections checkbox, if applicable. This checkbox is only visible if the service line is eligible for collections. The service line must have a balance greater than zero, must be in payer responsibility, and must not already be in collections.
12	To distribute money to miscellaneous income, click Add in the Misc Income table and complete the Transferring Money to Miscellaneous Income task.
13	To record notes on the service line, select the service line, and then click Edit Notes. The Edit Note window opens. Complete the following information: Enter or update notes in the Notes field. Click OK. The note is displayed in the Notes section under the Service Lines table.
14	Link or unlink an image to the distribution, if applicable.
15	If you make a mistake while entering data in a service line, click Clear Line to clear all data entered, then enter the appropriate data.
16	When you are finished with the service line, do one of the following: To save the distribution and add another one, click Save & Add Next (or press Alt + V). Repeat all steps in this task for each service line distribution that applies to the claim. To save the distribution without adding another distribution, click Save (or press Alt + S). All distributions will be added to the Payment: New or Payment: [ID] page.