RXNT automatically advances the responsible party and generates a claim to the secondary or tertiary payer when you Save & Post an insurance payment. The claim will either be transmitted electronically or dropped to payer based on the claim filing method selected for the payer within your account.
How RXNT determines the responsible party
To determine the current responsible party, RXNT reviews the current cases associated with the patient encounter and the claim submitted for that encounter. The Insurance Payment screen manages how financial responsibility progresses by using line item statuses and the Requeue payer field.
1. Rework Denial
- Use this status when a payer denies the claim, but the claim is resubmittable.
- Line item fields cannot be edited in this status.
- Line items remain under the current payer’s responsibility and the claim is moved to the Denied / Left Open tab.
2. Accept & Rework Denial
- Use this status when a payer denies the claim, but you wish to accept any payment received and then rework the denial.
- Line item fields remain editable.
- Line items stay under the current payer’s responsibility, and the claim moves to the Denied / Left Open tab.
3. Awaiting Payment
- Select this status for line items that have not yet received payment from the payer.
- If a payer partially pays for an encounter, leaving some CPT codes unpaid, use this status for the unpaid line items.
- Line item fields cannot be edited, keeping responsibility with the current payer and moving the claim to the Denied / Left Open tab.
4. Ignore Line Item
- Use this status when no data entry is required for a line item in the payment.
- Line item fields cannot be edited.
- The line item remains under the current payer’s responsibility and the claim is moved to the Denied / Left Open tab.
5. No Requeue
- Select this option if the line item should not be requeued.
- Line item fields remain editable.
- The line item moves to the next payer’s responsibility without placing the claim in the Denied / Left Open tab.
For example, if you post a primary payer payment and set the line item status to No Requeue, RXNT:
- Advances responsibility to the next payer (secondary or tertiary, if applicable).
If a different status is selected, responsibility intentionally remains with the current payer.
ERAs & advancing claims
When a payment is received via an ERA (Electronic Remittance Advice), RXNT automatically links the payment to the appropriate encounter(s).
Crossed-over claims
For crossed-over claims, RXNT automatically sets line item statuses to No Requeue. This allows responsibility to advance without sending the claim to the Denied/Left Open tab.
For example, if the primary payer is Medicare and Medicare has crossed the claim over to the secondary payer:
- RXNT automatically sets the line item status to No Requeue.
- Responsibility advances to the next payer without requiring manual action.
- The claim is not placed in Denied/Left Open because Medicare has already forwarded it.
Selecting any other status will keep responsibility with the current payer.
Out-of-order payments
In some cases, payments may be received out of sequence.
If a payment is received out of order, RXNT automatically requeues the claim to the highest-priority unresolved payer.
For example, a secondary payer submits payment before the primary payer:
- RXNT recognizes the primary payer has not yet made a payment/resolved the claim.
- The claim is automatically requeued back to the primary payer for processing.
This ensures claims always return to the correct payer order.
Requeueing denied and re-billed claims
When posting a payment for a rebilled claim (a claim that was denied and then resubmitted to the same payer), follow these steps:
- Please ensure the line item status is set to No Requeue if you agree with the payment received.
Same payer re-payment
- If the same payer issues an additional payment, the system will not automatically requeue the claim. In this situation, the claim must be manually resubmitted.
- For example, if an insurance payer sends a second payment adjustment or correction for a claim that was already processed, the system will not recognize this as a reason to requeue the claim automatically. To ensure the claim is processed correctly, you must manually resubmit it to the payer.
Payment reversed and reposted
- If a payment is reversed and then reposted, the system will not automatically requeue the claim. In this case, the claim must be manually resubmitted.
- For example, if a payment is initially posted, later reversed, and then reposted, the system will not automatically requeue the claim. To continue claim processing or billing, the claim must be manually resubmitted to the payer.
Key takeaways
- RXNT automatically advances payer responsibility when payments are posted.
- Line item statuses control whether responsibility advances or remains with the current payer.
- ERA and crossed-over claims streamline advancement without manual requeueing.
- Out-of-order payments are corrected automatically to maintain proper payer sequence.
- Reversed payments require manual claim resubmission.