Insurance Payment Posting - Beta Release

Posting insurance payments is not just about recording financial transactions, it's about ensuring financial accuracy, resolving claims efficiently, maintaining compliance, and providing insurance companies and patients with clear billing information. RXNT’s insurance payments help you post payments quickly by guiding you on error correction and establishing a clear hierarchy of steps on payment posting.

Navigate to insurance payments

Click on the Insurance Payment tab in the top Navigation Bar. 

All insurance payments are listed on this screen. 

The Unposted tab contains insurance payments that are ready to be reviewed and posted. This includes ERAs that have been received and processed successfully in the system and manual payments that have been saved. 

The In Progress tab contains insurance payments that are in the process of being posted. Once completed, the payments will move to the Posted tab. 

The Posted tab contains all insurance payments that have been posted. 

The All tab contains all insurance payments regardless of the category. 

To search for payment within a specific date range, simply adjust the Date From and Date To fields and click Search

Create insurance payments

Click +New Payment

Select the Payment Method from the dropdown menu. If the method selected is Check or Electronic Fund Transfer, enter a check or electronic fund transfer number.  If you enter a check or EFT number that has already been used, you will receive an error message indicating that it’s already in the system. Enter the Payment Amount and Payment Date

The Payment Number will be left blank until the payment is created. Adding a Payer and Penalty amount is optional. The Payer selected here is used for reporting and display purposes. Users can select a payer for each encounter on the next screen. 

The Payment Unapplied amount will be equivalent to the payment amount until payments are assigned to the line items. As soon as payments are assigned to line items, the Payment Unapplied decreases by the assigned amount, and the Payment Applied amount increases by the assigned amount

Click Create Payment

Link patients

Search the patient by Last Name, First Name, Account #, Chart #, or Claim # and select the patient to link it to the payment. 

When using any of the search options, entering the initial three characters is sufficient.

To add new patients into the system click the + Sign. This will automatically open the Patient Profile screen. Once you enter and save the patient information, the patient will be linked to the payment automatically. 

After a patient is linked, you can link more patients by following the process mentioned above.

You can unlink the patient anytime by clicking the Chain icon. 

A confirmation popup will appear, click Unlink.

Link encounters

The Encounters section displays three tabs Linked, Unlinked, and Unlinked & Settled. The Unlinked tab will be selected by default when linking a new patient. It contains encounters associated with the patient that are not yet linked to the payment. 

The Unlinked & Settled tab contains all unlinked encounters including those with a zero balance. Encounters under each tab will be in chronological order, from the oldest to the most recent. 

Click the Link Chain icon to link the appropriate encounter.  

The encounter will be placed in the Linked tab.

Please be aware that upon taking the following actions, the screen will automatically save: 
  • Linking a patient 
  • Linking an encounter
  • Switching between patients
  • Switching between encounters
  • Adding a new encounter
  • Adding a new patient.

The last saved time will be displayed at the top of the screen before you proceed further. This auto-save will not save a version in the history. The history of changes will only be saved when you click the Save button.

When clicking the Link Chain icon under the Linked tab, encounters can be unlinked and placed back into the Unlinked tabs. A confirmation popup will appear, click Unlink

Payment summary

The payment details entered earlier and the Posted Date can be found at the top of the screen. If necessary, this information can be edited before posting the payment. 

Line items

In the encounter line item section, enter the payment details.

Select the Payer. This payer drop-down is populated from the selected encounter’s case. The line item balances and Requeue payer are assigned correctly based on the chosen payer.

Select the Payment Type. This is populated from the payment transactions saved in the system.

Enter the Allowed Amount. Once you’ve entered the Allowed Amount the Disallowed Amount will auto-populate for payers. However, both these fields can be edited. 

If applicable enter a Co-Insurance (PR-2), Co-Payment (PR-3), Dedictiable (PR-1), or Other Patient Responsibility (OPR) in the respective fields.  

Enter the Payment Amount

If applicable enter a Write-Off amount.

The Adjustment Total amount will auto-populate from the Disallowed and Adjustment Amounts

Choose the Adjustment Type from the dropdown menu, which includes Insurance or Patient.  

Select the Adjustment Code from the dropdown menu. 

If applicable enter the Adjustment Amount

It's important to balance the payment when an insurance payer is the next responsible party. Balance the payment by assigning the line item insurance balance to one or more fields - Deductible, Co-Insurance, Co-Payment, and OPR.

Line item statuses should be selected when a claim has been denied, needs to be resubmitted, is awaiting payment, or if a line item needs to be ignored. Line item statues include:

  • Rework Denial - use this status when a payer denies the claim, but the claim is resubmittable. In this status, line item fields cannot be edited. 
  • Accept & Rework Denial - use this status when a payer denies, but you wish to accept that payment and then rework the denial. When this status is selected, you can edit the line item fields. 
  • Selecting either of these statuses keeps the line items under the current payer’s responsibility and moves the claim to the denied left open. 
  • Awaiting payment - Choose this to highlight line items that are yet to receive a payment from the payer. When a payer pays for only some CPT codes of an encounter and leaves out the rest, then use this status for line items that did not receive a payment in that check.
  • Ignore line item - Choose this if you are not doing any data entry for a line item in the payment. 
  • For both these statuses, the line item fields cannot be edited. This will keep the line items under the current payer’s responsibility and doesn’t move the claim to the denied/left open tab.
  • No Requeue - Choose this if the line item shouldn’t be requeued. The line item fields are editable for this status. Selecting this status will keep the line items under the current payer’s responsibility and doesn’t move the claim to the denied left open tab.

In the Requeue section, the information regarding the next responsible payer will be displayed. If the next payer in responsibility is the patient, the Requeue field will say "No Payer.” Additionally, when any one of the line item statuses is chosen, Requeue will say "No Payer.” Based on this logic, the Patient Balance and Insurance Balance will be listed in their respective fields. Hovering over the "i" icon will display the total past patient and insurance payments.

Miscellaneous payments

Click the + Sign to enter Miscellaneous Payments.

Select the Insurance, Payment Code, and Reason Code from their respective dropdown menus then enter the Payment Amount

Errors

Click the Errors tab to verify if any corrections are required before the payment can be posted. Clicking on the error will navigate you to the exact error. Once resolved, the error will move to the Resolved tab. The View All tab shows all errors.

When electronic remittance advices (ERAs) are received, the system will automatically populate the data and errors based on the information transmitted during the electronic data interchange (EDI) process. 

The fields highlighted in red are blockers, indicating that these need to be corrected before saving or posting the payment. Those highlighted in yellow are warnings, suggesting that information may need to be entered into the field.

You will not be able to post or save the payment if there are blockers. Ensure all blockers are resolved before posting or saving the payment. If you want to exit the payment without losing your current work, simply click on the X icon and click “Draft Save”. This will save your latest progress but will not save a version in the History. When a system error occurs during saving or posting, a message will be displayed on the screen. Retry saving or posting after a couple of minutes. If this does not resolve the issue or if you don’t want to wait for the system error to resolve, you can exit the screen and the data will be saved until the date and time displayed on the last autosaved indicator.  

Miscellaneous actions

To include a note, click Notes

Enter the note details, click the Alert checkbox then Add Note

The note details will appear below. Click Close to exit. 

To save the payment without posting, click Save. This will save a version in the History.

To save and post the payment, Click Save & Post

By clicking the three dots, you can opt to Attach Documents, View History, Access the Audit Log, and explore Site Settings or Delete unposted payments.

Click Exit, to cancel the payment. 

ERA payments

Navigate to the main dashboard and click on the Pending ERAs alert. This will take you to the ERA tab, where you can view both Pending and Resolved ERAs

In the Pending tab, you will see a list of successfully processed and errored ERAs.

Errored ERAs will have an explanation of an error and associated next steps in the Processed Status Message column. If you need further details, click on the Icon in the first column. Follow the instructions provided in the message. 

Click on the Payment Number for a successfully processed ERA. The insurance payments pop-up opens with all details populated from the ERA. By default, the line item details are on the right, and the Errors tab is on the side panel.

The ERA is processed with all validations populated within the payment - in the Errors tab. You'll see three views in the Errors tab: Unresolved, Resolved, and View All. By default, the Unresolved view will be shown. The tab shows errors that still need to be resolved. The Resolved tab lists errors that have already been resolved. The View All tab displays both unresolved and resolved errors. You can click either on the CPT code or the description to navigate to the exact error location or field. Once all errors have been corrected, they will be moved to the Resolved tab. After all blocker errors are resolved, the payment can be saved or posted. If you don’t take action on the warnings, they’ll remain in the Unresolved tab. 

It's important to note that some warnings cannot be resolved for an ERA payment. For example, if the ERA cannot find some encounter line items, a valid claim is missing, or an adjustment code cannot be found, such warnings will not be resolvable. Some of these warnings will be displayed when hovering over the warning icon on top of the payment, and some will be displayed within the error banner. The warning message will explain the steps to take.

You can identify such warnings by their display location or behavior—when fields aren’t highlighted for that specific warning or when the message is displayed when hovering over the warning icon on top of the payment.

A special blocker error occurs when the ERA payment is received at the encounter level. Such an error is displayed within the error banner and will be resolved once you click the “Resolve” button. 

If you want to quickly post ERA payments, navigate to the Errors tab as soon as you open an ERA insurance payment, resolve all blockers, and proceed to post the payment.

Next to the Errors tab, there is a Patients & Encounters tab. Click here to find a list of all patients and encounters associated with the ERA. From here, you can link/unlink encounters or patients, add a new encounter or patient, and, if needed, access the patient dashboard, patient profile, encounter screen, cases, ledger, and encounter screen.

The payment details are located at the top of the screen. Below the payment details, you will see the encounter and line item details section.  Some fields are highlighted in red to indicate required information, while those in yellow serve as warnings. For your convenience, all line items are pre-populated with information from the ERA. However, all pre-populated details can be edited.

If there is a denial and denial management is turned on for your company, the line item status changes to “Accept and Rework Denial,” and the denial code gets populated. The denial amount will be 0, except for special cases.

If there is a cross-over claim, the line item status changes to “No Requeue.”  

If there is a requeue payer, the Requeue Payer field displays the payer name. However, you can change the line item status based on your practice’s workflow.

Most of the time miscellaneous codes will be populated based on the ERA’s PLB. If not, add miscellaneous payments by clicking the Plus Sign located in the top right corner. From the dropdown menu, select Insurance. This menu will display payers associated specifically with the patient's encounter case. Choose the Payment Code from the dropdown menu. 

Here, you'll see insurance payment transactions that have already been created as payment transactions. Then, select a Reason Code from the dropdown menu. There are more than forty distinct reason codes available, each serving specific purposes in various contexts. These codes offer a comprehensive selection to accurately categorize and describe payments or refunds. Input the amount in the Amount field. 

Lastly, to print the ERA or its summary, click on the icons Print ERA or Print ERA Summary located at the top right of the screen. If you wish to save the payment without posting it, select Save. Alternatively, to save and post the payment, choose Save and Post. It's important to resolve any blocker validations before proceeding with either action. Resolving blockers is addressed in an earlier video in this course. 

To exit the payment without resolving blockers, simply click the "X" button and select Draft Save to save your progress. Additionally, you can access options such as attaching documents, viewing history, checking the audit log, site settings, and deleting the payment by clicking on the three dots icon located in the top right corner.

Helpful tips and items to note: 

  • If the patient pays first for a visit(co-pay), the patient payment is not considered in the insurance balance billed to the next payer in priority. Patient payments are considered only in the line item balance.  This is done so that the following payers in priority are billed the maximum amount. This will ensure that maximum reimbursement is received. Remember to always balance to the Insurance Balance so that the correct amount is billed to the payers next in priority.
  • The Requeue Payer field shows the next payer in responsibility for each line item. For each line item, the order is as follows: Primary → Secondary → Tertiary. If a payer makes an out-of-order payment, the claim gets requeued to the higher priority payer from the remaining payers.
  • When claims are crossed over, the line item status is automatically populated to No Requeue.
  • Errors and warnings have different behaviors depending on their type:  
    • The error banner contains validations grouped by the encounters. All line item errors are displayed under each encounter.
    • Blockers are indicated in red. Payments cannot be saved or posted until blockers are resolved.
    • Warnings are indicated in yellow. Payments can be saved or posted with active warnings.
    • Some errors are displayed at the top of the payment by hovering over the warning icon in yellow or red. Again, red indicates blocker errors, and yellow indicates warnings. The red icon can also indicate system errors.
    • Some warnings cannot be resolved for an ERA payment. For example, if the ERA cannot find some encounter line items, a valid claim is missing, or an adjustment code cannot be found. Such warnings will not be resolvable. Some of these warnings will be displayed when hovering over the Warning icon on top of the payment, and some will be displayed within the Error banner. The warning message will explain the steps to take. You can identify such warnings by their display location or behavior—when fields aren’t highlighted for that specific warning or when the message is displayed when hovering over the warning icon on top of the payment.
    • A special blocker error occurs when the ERA payment is received at the encounter level. Such an error is displayed within the error banner and will be resolved once you click the “Resolve” button. 

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