Let's delve into the steps for adding an insurance payment and subsequently posting it. Additionally, we will explore some related actions that can be taken.
Topics Covered
- How to Add & Apply an Insurance Payment
- How to Add Migrated Balances & View Migrated Payments
- How to Transfer or Refund Insurance Payments
- How to View Different Types of Transactions
- How to View Documents & History
- Insurance Information Tabs
- Manage Secondary Insurance Payments
Let's get started!
Watch this video to learn about the actions on Insurance Payment Receipts.
Explore this video for a quick walkthrough on Posting Insurance Payments and Adding Migrated Balance.
Adding an Insurance Payment
Navigate to the System Menu > select Insurance Payments.
- Click the + Add Insurance Payment at the top right.
- Select the Carrier from the drop-down list. This is used mainly for reporting purposes.
- Enter the Payment Details.
- Select your practice's customized flags to enable users to identify or classify insurance payments.
Note: Practices typically use these flags for payments with issues, multiple claims, or chargebacks. You can create your own flags in Practice Settings > Payments & Billing > Insurance Payments > Insurance Payment Flags > + Add Flag > Save. |
- Click Add Receipt and Apply. If you want to add a receipt without applying, click Add Receipt.
- Your new Payment will be ready for you to apply to claims. Click on the slide-out on the left to reveal it.
Insurance Payment Posting
To apply the added payment to a claim, perform the steps below.
- Once the receipt is created, select the receipt from the 'Show Insurance Receipts' slide-out.
- Select the Patient from the drop-down menu.
Select the intended Apply Method payment procedure. You will find five different options.
1. Pending Payment
'Pending Payment' is the default setting of the claim payment. It signifies that the claim has been sent out by CareStack and is awaiting action from the payor. If there is no pending payment, choose other methods.
2. Paid as Expected
'Paid as Expected' status means that the carrier has paid the exact amount expected for the codes in which the claim was sent out. Upon clicking on Submit, the payment gets posted and will be visible in the ledger. You can add the Claim Remarks.
3. Add Claim Level Payment
Select this option If you want to apply insurance payments to the whole claim amount by completing them on the total claim amount, instead of posting them through individual codes. You can decide what to do with the difference amount, once CareStack automatically calculates the difference between the insurance paid and the insurance expected.
i. Enter the Insurance Payment amount. You can see the Difference Amount on its side.
ii. Select an Action. Click Add More Adjustments to apply additional adjustments. You can select the Adjustment Code, Type, and Amount.
4. Add Line Level Payment
Select this option to post the payment for each code individually.
i. Click the + icon against the intended codes.
ii. Select the Adjustment Type, Adjustment Code, and Adjustment Amount.
5. Mark Claim as Denied
Select this option to mark the claim as denied as Insurance carriers can reject the claims due to any reason. Once this code is selected, we would have to specify the reason for rejection using the Group Code and Reason Code, which will be mentioned in the Insurance EOB received. You can also enter Remarks before submitting.
- Once the Apply Method is selected, click Submit.
| Note: CareStack will automatically check off the 'Close Claim' option to close the claim when you click 'Submit'. You can uncheck this if you would like to keep the claim open. |
| Tip: To view any closed claim, select the Apply Payment tab > click Show Closed Claims. |
Payment Posting for Membership Credited Code
When a claim is raised for a membership credited code:
- A star icon will indicate that it is a membership credited code or a membership benefit has been availed.
- You can only edit the Insurance Paid amount as a Line Level Payment.
- Any additional insurance payment that you do over the code will be received as an overpayment and will be credited to the patient.
- The insurance amount for any membership credited codes will be zero as the entire amount will be discounted as membership credits.
- You will not be able to perform a claim level payment or adjustments.
To view migrated payments,
- Navigate to the System Menu > select Insurance Payments.
- After selecting a receipt, select the Migrated Payments tab .
To add a new migrated balance,
- Click + Add Migrated Balance.
- Enter the required details such as Location, Provider, Date of Service, Patient Amount, Insurance Amount, etc. You can add your Remark before adding a new migrated balance.
- Click Save.
To make an adjustment for a migrated balance related to an insurance payment posting,
- Enter the Insurance Amount to change.
- Select the required Adjustment Type, Code, and Amount.
- Click Submit.
To do a transfer or refund, perform the steps given below.
- Navigate to the System Menu > select Insurance Payments .
- Select the Transfer / Refund tab after selecting a receipt.
Transfer Credits to the Patient
On the left hand side, you can see a Transfer Credits to Patient.
- Enter the required information.
- Transfer Amount: The amount required to transfer to the patient.
- Patient Name: Name of the patient who should receive the transfer.
- Claim Details: Claim details of the patient.
- Location: Location of the patient.
- Remarks: You can add remarks as to why this transfer is taking place.
- Click Transfer.
Refund Credits to Insurance
On the right hand side , you can see the Refund Credits to Insurance section.
- Enter the required information.
-
Refund Amount: Enter the dollar amount that you would like to refund to this Insurance Carrier.
Note: You will only be able to refund the Available Credits on the receipt. To refund an amount that has already been applied toward a claim, you will first need to reverse the transaction(s). - Refund Date: Verify the date this refund is made.
- Payment Type: Select the mode of this refund, whether it will be a direct transfer, or check, and so on.
- Location: Select the location this refund should be coming from.
- Patient Name: Select the name of the patient to which this refund pertains, if necessary.
- Claim Details: Select the patient's claim to which this refund pertains, if necessary.
- Remarks: Enter any necessary remarks (this will be displayed on the Memo line if printing a refund check with this transaction).
-
Refund Amount: Enter the dollar amount that you would like to refund to this Insurance Carrier.
Click Refund. To print a receipt, click Refund and Print. To print a check, checkmark the Print Refund Check checkbox.
- In the Transactions section, you can view all transactions performed on the other three tabs including Apply Payment, Migrated Payments, and Transfer / Refund.
- Applied Payments: You can view all applied payments here. To reverse any payments, select the required payment and click Reverse Payments. You can also Reverse Claim Payment.
- Click the pencil icon to edit the Insurance Paid amount.
Click here to learn how to reverse claim transactions from the insurance payment page.
Provider Level Adjustments: You can view all provider level adjustments here. To reverse any adjustment, select the required provider level adjustment and click Reverse Adjustments.
Refunds: You can view all refunds here. You can Print Receipts, Print as Refund Check, and Reverse Refunds after selecting the relevant checkbox and clicking on the corresponding action button.
Transfers: Under this tab, you can see all the transfers with their Date, Receipt#, User's Name Patient, and Claim Details.
Documents
You can view all documents related to the insurance claim here. You can perform several actions such as Print, Delete, etc.
- To delink a receipt, select a document > click Delink from Receipt.
- Click + Add Document to add documents to the claim. Scan or upload files, or select existing documents from the library.
History
- You can view all transactions or receipts in this section, such as all payments, reversals, provider adjustments, etc.
On the right side of the screen, you can see some information regarding the insurance claim. There are 4 tabs for Apply Payment, and the content displayed will change based on the selected tab. The sections in these tabs are collapsible.
- Receipt: This tab is available for other action tabs as well. It displays all receipt details such as Receipt #, Deposit Date, Default Location, etc.
- Patient: Shows Patient Information related to the claim.
- Code: Displays the Codes related to the claim.
- Plan: Shows Plan Information related to the claim.
- You can add flags to this section, if needed.
- From the Receipt tab, select the Flag > click Update Flag.
You can make use of the quick links under the Patient tab to navigate seamlessly through patient's records.
Check out this GIF for a quick overview.
Let's explore the key steps to follow when handling a secondary insurance payment. It is important to apply the payment correctly and ensure the Insurance Responsibility tab reflects the updated balances. Doing so helps maintain accurate patient ledgers and facilitates proper claim tracking.
To apply the payments,
Navigate to the System Menu > select Insurance Payments.
Select the required Insurance Receipt.
- Select the desired patient.
- Select Add Line Level Payment.
- In the Insurance Responsibility section, increase the insurance responsibility in order to incorporate the amount paid by the secondary insurance. The value should be Primary Payment + Secondary Payment ± Adjustments.
- Under Insurance Paid, enter the amount paid by the Insurance.
Click Submit.
A toast notification will appear on the top right stating, 'Applied Successfully' .
Practices can use this comprehensive guide to understand the different aspects of insurance payment posting and learn to manage insurance payments efficiently.