Add: to add a new Remittance
Search: to search Remittance
Supplementary Search: to search Remittance voucher patient wise
ALL: this drop-down helps to search for all (posted and entered) Remittances; or individual (either posted or entered) Remittances.
Insurance: name of the Insurance Company that has sent the Remittance Advice, this value can either be searched and selected or entered directly or auto-completed. If a value is entered
then it is taken as a third-party (Carrier) after confirmation on a pop-up message.
Note: the search for Insurance Company also displays the name of its associated carrier if it has been defined in the Insurance Master.
Check No: Check number or the EFT (Electronic Fund Transfer) trace number -incase of an online transaction.
Note: It becomes mandatory to enter the check details if the Check amount is entered; also, it becomes mandatory to enter the 'Reference No.' for electronic remittance.
Check Date: date on which the Check is issued; This is an optional field.
Check Amount: the amount of the check being issued.
Remittance No: is the auto-computed value, giving the remittance a unique identity; The Prefix and length is generated using the property era.docno.prefix and era.docno.length
Remittance Date: date on which remittance is created; current date is displayed by default but it is an editable field (user can change or edit the date)
Allocated Amt: is the amount allocated by the Insurance (payer) towards the claim(s). The sum of 'Paid' and 'Excess Amounts' entered for all claims on the EOB/ERA adds up to Allocated Amt.
Post Date: is the exact date when the Claim entry was posted externally(as claim created and sent from PrognoCIS have the 'Sent Date' generated automatically).
Note: If Batch creation is applicable then the date is automatically SET to the Batch creation date and it becomes a non-editable field but if Batch No. is NOT applicable and EOB has NOT been reopened then user can edit the date to a suitable date.
Batch No: is the Check deposit batch number. This is automatically generated by PrognoCIS for each batch of Remittance Voucher. This feature is enabled only if the property: billing.use.receipt.batchno is set to 'Y'. If the user has rights to create or to start a new batch then the button: “+” is enabled and the user is able to select an existing open batch or create a new batch (there can be only one open batch for a creator). If this feature is applicable then the user will not be able to post a voucher until a batch number is selected.
Attach:
attach EOB for the remittance voucher;
use this button to attach any document to the Remittance. Typically this will be the scanned copy of the actual EOB.
In case of an ERA, the EDI835 file received is attached by the program.
The tool tip for this button changes from word “Attach” to “Detach” if a file is already attached.
View Attachment: helps user to the view the EOB attached as per
convenience.
Remittance Comments: enter comments (if any) with regard to the remittance being entered or edited.
Note: once Notes are entered, the image changes from a blank paper to lines.
Status: Displays status as 'Entered' or 'Posted' of the remittance voucher.
Remaining Amt: is the Check Amount - Allocated Amount. If “ era.remittance.useadvance” is set to Y, Remaining amount on Remittance Voucher will be moved To/From Advance, depending upon whether Remaining Amount is Positive/Negative.
Reopened Vouchers:
Click on this image to invoke the search to enlist reopened vouchers for the currently selected remittance voucher. If this remittance was reopened at least once, the invoked search will list the reopened voucher(s) with Document No., Name of the Medic Person who reopened it, Date Time when the voucher was reopened, the Voucher Amount and the Status. Note that, reopened vouchers are marked as ARCHIVED and are indicated by Status as A.
User can select any of the reopened voucher and load it to explore the details. When reopened Remittance voucher is loaded, header portion of the voucher is highlighted with Yellow border. User can navigate to Original Remittance voucher by clicking the same button. When the search is invoked from a reopened remittance voucher, it will list the Original Remittance voucher at the beginning of search list with corresponding status. Also, other instances of reopened vouchers will be enlisted below the original voucher, allowing user either to navigate to the Original Remittance Voucher or explore the other archived copies, if any.
Select Claims Search Button: Click on this to see a list of Outstanding Claims pertaining to this selected Insurance and Attending Provider. (Note that claim records for Primary and Secondary Insurance Bills Only are considered)
Claim Details: On selecting a claim the details are shown in the bottom table. The Charge Billed is displayed and the user can enter all other amounts.
Insurance Details: takes the User to the screen: Patient Insurance.
Patient Billing Notes: opens the screen: Patient Billing Notes.
CoPay Details: takes the User to the screen: Encounter CoPay collected screen
Claim Details: takes the User to the screen: Edit Charge provided the Billing Status is at least 'Ready to Bill'.
Patient Statement: takes the User to the screen: Patient Statement using the default template SET in properties.
Patient A/c: takes the User to the screen: Patient Account .
Print Secondary CMS: is the option available if the patient has Secondary Insurance. Once any partial payment is
received
from the primary insurance then a claim is built to the secondary insurance with the primary ERA attached.
Track Status History: tracks the claims status as in, the number of times the claim got sent, rejected, and reopened.
Ready to Post: The remittance entry, once saved becomes 'Ready to Post'.
On selecting a claim (middle table on screen) the row has a field to enter Allocated Amount. The List Box following this field has many options based on which the Allocated amount can be assigned / apportioned to all the rows in the details table below. The Allocated Amount is apportioned on the basis of Allowed Amount in one of the following ways:
- Manual - Do Not Apportion. Paid amount will be entered by the User. This is the most likely option selected.
- Serial - Starts Apportioning the Amount from the First Row to the Last.
- Lowest to Highest - Apportion the Amount against the smallest charge first, if there is any Amount left over apportion against the next higher charge and so on.
- Highest to Lowest - Apportion the Amount against the highest charge first, if there is any Amount left over apportion against the next lower charge and so on.
- Prorated - In proportion to total Allowed Amount i.e. = Allowed Amount for a Charge * Allocated Amount / Total Allowed Amount. This option is unlikely to be used, since the amount will become fractional.
- Bal to WO. - This actually does not work on the Allocated Amount. It just assigns all Balance Amount to the corresponding Write Off Amount. For want of a better place, this option has been included in the List Box here.
On selecting a claim the details are shown in the bottom table. The Allowed amount is computed at the beginning at the time of charge entry creation, depending on the Insurance company and its applicable schedule (Settings > Configuration > Insurance). The Biller will certainly need to edit this amount based on the actual specified in the Insurance Remittance Advice.
Bill Amount: The Amount billed to Insurance Co. for the charge, Allowed Amount is computed at the beginning at the time of charge entry creation, depending on the Insurance company and its applicable schedule (Settings > Configuration > Insurance). The Biller will certainly need to edit this amount based on the actual specified in the Insurance Remittance Advice.
Paid: It is the actual amount paid in this remittance
Co Ins: Amount is the amount to be collected from Secondary Insurance. Note, if this remittance was against Secondary insurance, then the Co Ins Amount column is disabled.
Co Pay: It is the one to be collected as Co Pay from the Patient. Note, if this remittance was against Secondary insurance, then the Co Ins Amount column is disabled.
Deductible Amount: It is the one to be collected from the Patient
Not Covered: It is Not covered by the Insurance Company, as such must be charged to the patient.
Balance Amount: It is = Allowed - Paid - Co Ins - Co Pay - Deductible - Not Covered. It is unlikely that there will be any Balance Amount, when the Insurance Company makes a payment.
Write Off Amount: In case there is a Balance Amount, Biller can enter the same Amount under this column and so that the Bill amount and receipts are fully matched and adjusted. If the Balance Amount is not written Off, the Bill will remain as outstanding and will appear in every statement / report. Needless to say, only if the Balance Amount is too small it will be written off.
Action: The permitted values are,
- Approval - Default selection.
- Denial - Denied by insurance.
- Pending - Bill not considered and is pending
- Appealed - If the Insurance had rejected it once and it was resubmitted
- ReBill - ReBilled by Insurance
As the values are modified, note that the column totals are billed up. The Paid Amount in the Claims line in the middle table is updated. The Assigned Amount and balance Amounts are updated in the header area.
The document can be marked as Ready to post only if the Check Amount is equal to Allocated. Once it is marked as Saved, then it cannot be modified. On save, if there was a Secondary Insurance for the encounter (and this remittance was against the Primary insurance) then the Co Ins Amount is Billed to the Secondary insurance automatically, and the entry can be seen under Claim > Send option. Like wise the Patient Responsible Amount is Billed to the patient. Patient Responsible Amount = Co Pay - Deductible - Not Covered - Co Pay Amount collected in the EMR against this visit (provided this remittance was against the Primary insurance). This entry can also be seen under Claim > Send option.
On post records in the bottom detail table, against which No amount is entered will be deleted.
Remarks: To enter any specific comments about that particular charge.
Excess Amount Details At times the Insurance pays a certain amount towards a claim, but the amount billed is less. This difference of amount between the 'Allowed Amount' and the actual charge code (billed) is the 'Excess Amount'.
Total: Shows the various total of all the records
Excess Amt: is the total (excess) amount from the amount allocated by the Insurance Company (payer)