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.
Let's get started!
Topics Covered
- Add & Apply an Insurance Payment
- Add Migrated Balances & View Migrated Payments
- Transfer or Refund Insurance Payments
- View Different Types of Transactions
- View Documents & History
- Insurance Information Tabs
Watch this video for a comprehensive walkthrough.
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. 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. Create your own flags in Practice Settings > Payments & Billing > Insurance Payments > Insurance Payment Flags > + Add Flag > Save. |
Click Add Documents.
In the Documents slide-out that appears,
- Click Browse Document or Scan Documents to upload files.
- All uploaded files are automatically selected to be linked to the receipt.
- Closing the document slide-out without linking to a receipt triggers a Warning.
- Click Yes to link or No to skip.
- 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. There will be four different options.
1. 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.
2. 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 Different 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.
3. 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.
4. Mark Claim as Denied
Select this option to mark the codes 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.
Watch this video for a comprehensive walkthrough.
To view migrated payments,
- Navigate to the System Menu > select Insurance Payments.
- Select the intended receipt.
- Select the Patient from the dropdown.
- 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.
Watch this video for a concise summary.
To do a transfer or refund, perform the steps given below.
Navigate to the System Menu > select Insurance Payments.
- Select the intended receipt.
- Click Transfer/Refund.
Transfer Credits to the Patient
On the left side of the page, you can see the Transfer Credits to Patient section.
- 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 side of the page, 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 being 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).
-
- Click Refund.
- To print a receipt, click Refund and Print.
- To print a check, check the Print Refund Check box.
Watch this video for a comprehensive walkthrough.
- Applied Payments: You can view all applied payments here. To reverse any payments, select the required payment and click Reverse Payments. You also have the option to Reverse Claim Payment.
- Click the pencil icon to edit the Insurance Paid amount.
Click here to learn more about reversing claim transactions from the insurance payments 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 desired 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 tab, such as all payments, reversals, provider adjustments, etc.
Watch this video for a concise summary.
On the right side of the screen, you can see some information regarding the insurance claim. There are 2 tabs for Apply Payment, and the content displayed will change based on the selected tab.. The sections in these tabs are collapsible.
1. Receipt:
- This tab is available for other action tabs as well. It displays all receipt details such as Receipt #, Deposit Date, Default Location, etc.
To add Insurance Payment Flags,
- Select the Flags from the dropdown.
- Click Update Flag.
2. Patient
- Displays Patient Information related to the claim.
- You can make use of the quick links under the Patient tab to navigate seamlessly through a patient's records.
- The Account Summary section under quick links shows the details such as Patient Due, Insurance Due, Total Due, Unapplied, and Net balance, in separate views for Patient Balance and Account Balance.
- To clear the unapplied credits for a patient or account member, click Apply Credits.
Practices can make use of this super elaborate guide that explains different parts of the insurance payments posting and learn to use the insurance payments efficiently.