If the voucher is Posted – All posted vouchers are found under Remittance → Processed.
If the voucher is Not Posted - All Entered EOBs/ ELEs are found under Remittance → Unallocated.
Non posted Remittance list also appears on the Billing Home screen under the Not Posted section. The remittance or payment received from Insurance gives the detailed breakup of amounts paid against each charge that was claimed. Remittance advice is received either in the form of Explanation Of Benefit (EOB) as a fax or document or Electronic Remittance Advice (ERA). The EOB is manually attached whereas the ERA is attached automatically.
This sub-menu is displayed upon hovering the cursor over the EOB/ERA menu only to users assigned with the Upload835file User Role. On click, a Remittance search popup is invoked which displays a list of all EOB/ERA vouchers present in PrognoCIS. Upon clicking on a record from this list, users are redirected to the Remittance EOB/ERA screen. This is the same screen that is invoked via Remittance → EOB/ERA.
This sub-menu is displayed under the Receipts option upon hovering the cursor over the EOB/ERA menu only to users assigned with the Upload835file User Role. This menu allows users to upload EDI 835 files present on their system without having to go through the process of connecting to the client network and downloading the files.
On click, this option invokes the Upload EDI 835 Files popup which consists of the following:
- Clearing House dropdown: This dropdown displays the names of all active Clearing Houses available for the clinic which have the ERA Extension setup in the database. Only one Clearing House can be selected at a time from this dropdown.
- Upload Files:
Click on the Choose Files button to select the required files from a local folder on your system and click on the UPLOAD button to upload them.
If only one file is selected, then the name of the file is displayed next to the Choose Files button and if multiple files are selected
then the number of selected files is displayed.
A maximum of 10 files can be attached from this button.
If more than 10 files are selected and the UPLOAD button is clicked, then an error popup with the message:
Max number of attachments selected is displayed to the user.
The allowed file types and file sizes are defined in the properties 835upload.file.extn.supported and 835upload.file.size respectively.- 835upload.file.extn.supported: This property is used to define the allowed file type extensions for files that can be uploaded from the Upload File option. The default value for this property is DAT,TXT,CSV (corresponding to .dat, .txt and .csv respectively). If this property is left blank, then the default file extensions .dat, .txt and .csv are considered as the valid file types and can be uploaded as EDI835 files. Note that PDF files and compressed files such as ZIP files are not considered valid file types in this property.
- 835upload.file.size: This property is used to define the maximum file size in kilobytes (kB) for files that can be uploaded from the Upload File option. This property accepts numeric values between 1 and 10000 (1kB to 10MB). If a value less than 1 or greater than 10000 is entered in this property, then an error message: Entered value must be > = 1 and < = 10000 is displayed on clicking the save button on the Properties Master screen. The default value of this property is 2000 (2000kB or 2MB). If this property is left blank, then the default file size of 2000kB is considered.
Suppose the value defined in the property 835upload.file.extn.supported is DMT,CSV,TXT,RMT. On selecting a file with an extension that is not present in the property, an error popup with the message: The selected file extension is unsupported. Only DAT, CSV, TXT and RMT extensions are supported. Please verify and choose a file with the correct extension as indicated in the property ‘835upload.file.extn.supported’ is displayed on clicking the UPLOAD button.
The allowed file size of the files is up to a maximum of 10240kB. If a file or multiple files are attached together and exceed the maximum allowed value as per the property, then an error popup with the message: 1/Total file size (kb) exceeds maximum upload size limit of 10240kb is displayed to the user on clicking the UPLOAD button. 
UPLOAD button:
After selecting a Clearing House from the Clearing House dropdown and the files to be uploaded from Upload Files,
click on this button to upload the files.
If files are uploaded successfully, then a message:
<No of files> files are uploaded successfully is displayed in green color, else an appropriate validation message is displayed.
Upon successful upload, the attached files are saved in the EDI835FTP folder for the selected Clearing House.
Once the files are selected and uploaded, the system checks the allowed file extensions specified at the backend for the selected Clearing House.
If multiple comma separated extensions are defined for a single Clearing House, then the first value from the list is considered.
CLOSE button:
Click on this button to close the Upload EDI 835 Files popup.
The EOB/ERA screen consists of the following sections as follows:
- EOB Header Section
- Claim Details section
- Action buttons
- Error Messages
Add:
Click this button to create a new EOB/ERA Voucher.
Search:
Click this button to search for any other EOB/ERA Voucher present in PrognoCIS.
Supplementary Search:
Click this button to search for any Claim with Payment voucher associated.
All/Entered/Posted dropdown: Select an option from this dropdown to search for the selected type of Remittances. If All is selected then all (posted and entered) Remittances are displayed in the search; else individual Remittances in Posted or Entered status are displayed.
EOB/ERA screen in PrognoCIS is split into two sections:
- Header Level
- Claims & Charges
EOB Header Section
Payor: Name of Insurance company which has issued Payments. On EOB/ERA screen, if the payer selected is present in Insurance Master screen, it is termed as Insurance. If the payer name selected is free text and does not show up in Insurance Master, it is termed as Carrier.Pay Mode: Pay Mode is a mandatory field which cannot be blank. PrognoCIS supports 3 payment modes in the Pay Mode dropdown driven by property era.remittance.paymodes.
- Pay Mode as Check:
When the Check option is selected, a Show Details
icon is displayed next to the dropdown.
This icon invokes the Check Details popup, which has Check No, Check Date and Bank fields,
out of which, Check No is mandatory.
When Pay Mode is selected as Check, the date field on EOB/ERA screen is displayed as Check Date,
the amount field is displayed as Check Amt and the number field is displayed as Check No, and all 3 fields are mandatory.
A Check payment is received from Insurances when paper EOB is sent. - Pay Mode as Electronic/EFT:
Typically, when Electronic Payments are directly deposited in the Clinic’s bank account, the payment mode is EFT.
EFT stands for Electronic Fund Transfer.
Each such transfer transaction has a unique number called Instrument Number.
When ELEs or ERA i.e Electronic Remittance Advice are received from Insurances by Clinic through EDI 835 files, the payments are also mostly via EFT.
Very few Remittance Advices come electronically and check follows later.
When Pay Mode is selected as EFT, the Show Details icon is displayed as disabled next to the Pay Mode dropdown.
The is because there are no additional details to be noted for EFT like in case of Check or Card like Check/Card No.
When Pay Mode is selected as EFT, the date field is displayed as Receipt Date,
the amount field is displayed as Receipt Amt and the number field is displayed as Instrument #.
In case the money is received electronically and EOBs are received on paper, users can select EFT as the pay mode to keep track of payments.
If ELE or Electronic remittances and EOBs are both received electronically, then the pay mode is auto-selected to EFT and made non-editable.
PrognoCIS also populates the instrument # which is not editable. - Pay Mode as Credit Card:
Credit card payments supported by PrognoCIS include manual entry of credit card details and through Payment Gateways like OpenEdge (PayPros) and Integrity.
For Insurance payments using credit card through Payment Gateways, the Electronic Payment Gateway has to be first turned ON.
When Pay Mode is selected as Credit Card, the Show Details icon is displayed for manual entry
irrespective of whether CC Electronic Payment interface is turned ON or not.
A Credit button is shown as enabled when CC Electronic Payment interface is turned ON and a Merchant ID is present.
On clicking this icon, a Credit Card Details popup is invoked which has Card No., Card Holder and Card Type fields.
The Credit button is shown enabled only if the Credit Card Electronic Payment feature has been turned ON.
When Pay Mode is Credit Card, the date field is displayed as Receipt Date,
the amount field is displayed as Receipt Amt and the number field is displayed as Card No..
Payment is not received via Credit Card when ELE are received.
Check Amount/Receipt Amt: When Pay Mode selected is Check, the label of this field is displayed as Check Amt, whereas if Pay Mode is EFT or Credit Card, the label changes to Receipt Amt.
Check No: When Pay Mode selected is Check, the label of this field is displayed as Check No. If Pay Mode is EFT, the label changes to Instrument # having a character limit of 30 characters. Users can scroll the field from left to right to view all the characters present in the field. After posting the Payment, this field gets grayed out. If Pay Mode is Credit Card, the label changes to Card No.. The Card No. field stores only the last 4 digits of the card number.
Distribute Paid Amount:
This icon is available for Non-Electronic Remittances on the Remittance screen.
This icon is disabled for Electronic Remittance files which are downloaded in PrognoCIS.
Clicking on this icon, a popup is invoked.
A warning message: You are distributing the collected amount in proportion to the billed amount on selected claims.
Please hit OK to continue is displayed.
On clicking the Ok button, a Please Wait loader is displayed.
PrognoCIS calculates the percentile share of each charge row by billed amount and evenly distributes the collected amounts as per the same percentage.
When all claims are fetched on EOB and amounts are distributed and the remaining amount is not zero then a message:
Nothing to Distribute is displayed on screen.
When a claim is selected in an EOB and the user enters details in the Check Amt field on Remittance screen and clicks on this icon, a message:
Please save the voucher in order to use Distribute function is displayed.
Note:
For Non-Electronic Remittances, this icon is disabled till at least one claim is fetched on Remittance voucher and the remaining amount is greater than zero.
Remittance No: This displays an auto-created voucher number which by default starts with either ERA (for paper remittances) or ELE (for electronic remittances). This number is hyperlinked which on click invokes the EOB - Last Update Details popup and displays a basic Audit Trail of transactions such as name of user who performed the last modification and the date and timestamp at header and each Claim Charge row level. Remittance No is generated using the property era.docno.prefix and era.docno.length.
Remittance Date: Displays the date on which remittance was created. The current date is displayed by default here but it is an editable field so the date can be changed.
Allocated Amt: It 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: Post Date can be entered by user if Receipt Batch No is Not applicable and EOB is Not reopened and EOB is not in posted or achieved state. On manual creation of new EOB, Post Date gets auto populated as Today’s Date and to Run Date when ELE is processed when Receipt Batch No is not applicable. If Receipt Batch is applicable, this is set to the Batch Creation Date and the field is non-editable.
Batch No: This 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 turned On. 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.
If the property is turned On then the user will not be able to post a voucher until a batch number is selected.
Attach:
This allows 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.
The icon only attaches documents with extension txt, pdf, tif, 835, rmt, era.
If user tries to attach a document with any other extension then on Attach an alert message:
Only Specified Extensions Allowed: txt, pdf, tif, 835, rmt, era is displayed.
View Attachment:
This helps user to the view the EOB attached as per convenience.
Remittance Comments:
User can type in any notes relevant to the Remittance in the Remittance Comments popup invoked on clicking this icon.
The character limit of the notes is 1024.
If a note exceeding 1024 characters is entered, all the characters after 1024 characters will be truncated.
List of Reopened ERAs:
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 a 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.
Status: Displays the status Entered, Posted, and Archived. This is followed by Reopen in red if the EOB was posted earlier and then Reopened.
Remaining Amt: Remaining Amt is the difference of Received Amount and 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.
Back to Top
Claims and Charges Section
Select Claims Search Button: Click on this icon to see a list of Outstanding Claims pertaining to this selected Insurance and Attending Provider.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.
Recoup Search: It displays all claims which are posted, considering all the Insurance companies. Earlier, Recoup was allowed to be done multiple times. Now, once Complete Paid Amount is recouped then it will not be allowed to recoup again.
Patient Details:
Clicking on this icon, takes the user to the Patient Registration screen, for the Patient of selected (Blue background row) Claim in middle frame.
Insurance Details: Clicking on this
icon, takes the User to the Patient Insurance screen.
CoPay Details: Clicking on this icon,
takes the User to the Encounter CoPay collected
screen.
Claim Details: Clicking on this icon, takes the User to the screen: Edit Charge provided the Billing Status is at least 'Ready to Bill'.
Track Status History: Clicking on this icon tracks the claims status as in, the number of times the claim got sent, rejected, and reopened.
Claim Ledger: It displays the list of all
receipts/write-offs/adjustments made by insurance/patients against claim in
focus. Using button 'print', details displayed on Claim Ledger can be
printed.
Print Secondary CMS: This
option is 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.
Print Claim EOB HTML: This icon takes the user to generate Primary & Secondary EOB at claim level, Users will have the ability
to print claim level EOB and send it along with claims.
Note: This icon will be shown enabled and will
allow to print the EOB HTML as per Claim posted for the selected EOB when
there is a further (Insurance) responsibility present.
Patient Statement: Takes the User to the screen, Patient Statement using the default template SET in properties.
Claim Letter: Clicking on this icon, takes the user to Claim
letter screen.
Assign To: Clicking on this icon, takes the user to Claim Assign To screen.
Claim Notes: It
is used to write notes about the claim for internal documentation purpose.
Patient Billing Notes: Clicking on this icon, opens the Patient Billing Notes screen.
Refresh Claim Billed and Allowed Amts: It
recomputes the Bill / Allowed Amounts an reloads the Charge details in lower
frame.
Patient A/c: Clicking on this icon takes the User to the Patient Account screen.
Change Claim Insurance: This icon allows the users to change Insurance sequence or add Insurance on
a particular claim from EOB Screen.
WriteOff ChargeNext: With this option, balance can be transferred to next
entity such as Secondary / Tertiary Insurance or Patient or can be written
off.
Print Claim Appeal Form: With this option, allow to print the generated
appeal for a denied or disputed or retained claim. The icon is enabled only
when any of the charge codes posted on an EOB are either Denied or Disputed
or Retained. To Know more Click here
Ready to Post: The remittance entry, once saved becomes 'Ready to Post'.
EOB / ERA Screen contains only two sections Header Section, Claim header and third Charges section is merged into Claim header section in form of an expandable accordion; set to expand on a mouse click. When a Claim is selected from the search binocular the Claim level displays the accordion. On click of each claim, accordion is expanded to display the charge row details of a claim. Number of claims displayed in the Claims Accordion is dependent on property era.claims.per.page. The Min and Max accepted are 1 to 100.
For each claim row accordion the following details are displayed when accordion is expanded.
- Claim Table: This table displays the claim related information details in the accordion. The following fields such as PaidAs, A2 and DCN ICN are shown editable but only when accordion is expanded. User can make changes as required.
- Charges Table: This table displays information related to the claim charge code. When user clicks on the other accordion then existing accordion gets automatically saved.
- Post a single claim without posting the entire Remittance using the Post button.
- Unpost and Edit payments from a single Claim of the remittance without impacting other posted claims on the same remittance using the Edit button.
Post: This denotes when a Claim / EOB is yet to be posted and Edit
button
The claim row also Includes important information in reference to claims selected such as – Claim ID, Date of Service, POS, Patient, Paid As, Allocated Amt, A2 (Auto Bill Secondary), Primary Ins, Secondary Insurance, Tertiary Insurance, Provider, DCN / ICN Number
The Charges section presents the information at the charge level (It gives details of Charges which are reported on a selected claim and which are paid or accounted for in the EOB / ERA which is being posted
This section presents following information to the users:Charge Code, Modifier if applicable, Billed Amt, Contract Amt, Allowed Amt, Paid Amt, Coinsurance, Copay, Deductible, Not Covered, Balance, Excess Payment, Write off, Status / Action Section, Bill Patient Checkbox, Current Balance, Current Responsibility And Delete Checkbox. The following case is applicable only for RCM Clients. When the user denies the claim with ‘No Action’ and posts the EOB,if there is no task already created, now a task will be created with following user defined values - Assign To: AR Team, Source: Payment Team Action Required: Follow-up, Expected Date: Today and Comments:”Please work on denials”
If a task is ‘Open’, Expected Date ‘Past Date’ then it will not change to current date.
If the task is ‘Open’ and the Expected Date is a Future Date then it will set to Today’s Date.
If the task is ‘Open’ and the Expected Date is a Blank then it will set to Today’s Date.
If the task is ‘Closed’ and the Follow up Date is a Past Date then it will not set to Today’s Date.
If the task is Closed’ and the Follow up Date is a Future Date then it will set to Today’s Date.
If the task is ‘Closed’ and the Follow up Date is a Blank then it will set to Today’s Date.
Fields in Details Frame
Charge: This is the charge code for selected claim. The background color can be Normal. When the claim is selected for the first time for Primary Insurance OR Secondary Insurance Remittance. It is Yellow when it is an Additional Payment from Primary Insurance. It is Red when it is explicitly marked as Duplicate payment from Primary Insurance OR Secondary Insurance Remittance. The tool tip displays the Name of the Charge Code, the DOS( Date of service entered for the Charge code in claim) AND the Charge Balance if it is Not Zero.
Hyperlink O: When payment is posted on the same charge code from the same payment source then the O hyperlink is enabled.For example:When Primary Payment is posted and user is posting another payment from Primary insurance on the same charge code, then O button is shown enabled.
Hyperlink 'R': When any other receipt is posted on the same charge code then the R hyperlink is enabled.For example: When Primary Payment is posted and user posts the Secondary payment or the Patient Receipt on the same charge code then the 'R' Hyperlink is shown enabled.
Bill Amount: This is the billed amount for the charge code in a claim.
Contract: The Maximum allowable amount as per Provider's contract with that particular insurance carrier. The value in this section is controlled by Allowable Fee schedule as set up in PrognoCIS. (Read Only Field) By default this field does not have any direct impact on Calculations on the EOB. However it plays a key role while tracking Underpayments.
Adjust: The amount of monies which are applied towards Contractual Obligations or Contractual Adjustments. The adjustments are calculated automatically as soon as Allowed amounts are added.
Allowed: The maximum allowable amount as per EOB.
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 the 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.
Excess: User can enter the excess amount paid by Insurance along with its reason like Late Payment / Interest. Note that this amount does not affect the outstanding / AR for the charge.
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.
Status + Action: Users can select the status manually while posting EOBs from status and Action drop down at the charges section on EOB. The permitted values are, Approval - Default selection and Denied - Denied by Insurance.
Denied Status: Denials are posted in PrognoCIS with Denied Status at the Charge Level. By default when insurance carrier denies a claim, the balance is kept in the same bucket (Primary / Secondary / Tertiary) and is not moved to the next entity unless user explicitly takes action to do so. All Denials Claims are shown under AR/Follow-up → Denied claims list so that billers may take appropriate actions for the same. The Action window is invoked from all screens where denials can be accessed. For posting a denial, Selecting appropriate Denied Reason is mandatory. For Action codes: Write Off & Charge Next Responsible; Populating Action Reasons is mandatory. Any comment added in the Statement Comments section will be added to Patient Statements.
Denied - Action |
Description |
|---|---|
| No Action |
|
| W/Off | The charge on which denial is posted is written off and balance is zeroed out. |
| Charge Next Responsible |
|
| Rebill Creating a New Claim |
|
| Reopen Claim For Resend |
|
| Resend without Reopen |
|
| Insurance Agreed to Pay |
|
| Resolved |
|
| WIP |
|
Note:
When an EOB with Approved status is posted for a same claim which is denied
on initial EOB, an Action code 'Resolved' is updated.
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 the records in the bottom detail table, against which No amount is entered will be deleted.
PrognoCIS supports ability to Copy Denied Action and Action Reason for Claim Charge rows on Remittance screen.
Program has been enhanced and provided the ability on EOB, to Copy the denied reason to all denied Charge codes.
Consider a few examples:
Consider a Claim with multiple charge codes: 99214, 36415, and 43239. Insurance carrier denies this claim with reason “Patient cannot be identified as our insured”. Since this entire claim is denied, user would have to document the same denial reason for all charge codes. In order to support this following workflow is now supported.
User marks first charge row – 99214 as denied and populates denial reason as ““Patient cannot be identified as our insured”.
User only changes the status of the other two charge codes from approve to denied and closes the accordion
The denial reason is copied to all subsequent charge rows which do not have denial reason explicitly selected
PrognoCIS supports ability to Copy Denied Action to Other Charge rows
When all the Charge rows for a Claim are likely to be marked as Denied for the same reason, a new option Copy Action to Other Denied rows is introduced.
Consider an example:
Consider a Claim with multiple charge codes: 99214, 36415, and 43239. Insurance carrier denies this claim with reason “Patient cannot be identified as our insured”. Since this entire claim is denied, the user would have to document the same denial reason and Action for all charge codes. In order to support this following workflow is now supported.
User marks 99214, 36415, and 43239 as denied
From one of the charge rows, user selects denied action as ‘Charge Next Responsible’ and selects denied action reason as ‘Patients responsibility’ and checks the check box ‘Copy Action to Other Denied Rows’
The denial action & action reason gets copied to all subsequent charge rows which do not have Denial action and Action reason explicitly selected.
Bill Pat: This indicates that the charge code is directly billed to Patient.
Cur. Bal: Displays the current balance on Patient.
Cur.Resp: Displays the current responsibilty is on Insurance or Patient. This is enabled only when the remittance is saved.
Del : Selecting this checkbox will allow the user to delete a charge code off the Claim while posting payments.
Back to Top
Configure Phrases for Appeals for Denied and Disputed Claims
Appeal Phrases can be configured as follows:
- Navigate to Settings → Configuration → Group Types → Non system. New Group ‘DA’: DENIAL DISPUTED/RETAINED ACTIONS has been added in Group Types.
- Users can add and create their Appeal Phrases as required for their practice for the appeal process.
- Character limit with 1024 characters has been supported to be used as Appeal Phrases.
Impact of Appeal on Patient Account
- The ID displays the Attach ID and is hyper linked to invoke a copy of the form which was printed. On every print of the form from EOB a copy of the letter will get saved under Patient's account.
- Date column display the Date when Appeal letter was printed.
- Subject Line of the Appeal form label is displayed as Appeal DocNo: <<VOUCHER#) Claim: <<CLAIM ID>>.
- The Attached form can be deleted from Patient Account screen by navigating to Attached Document button and invokes the same popup.
The printed copy of the appeal form can also be seen from Claims letter screen under EMR Documents button. The form can be printed with Copy of Medical Records to respective insurances.
Dirty Flag
Dirty records are EOB/ELE records for which charge code on the Remittance → EOB/ERA screen has:
- Approved transaction with Amount in not cover.
- Approved transaction with Additional or Duplicate payment.
- Approved transaction with Billed Amount has been Adjusted.
- Denied transaction with Amount in not cover.
- Denied transaction with Additional or Duplicate payment.
icon is displayed for users, beside Remittance No, Claim Id and Charge Code when the property, era.835.set.dirty.flag is set to On. The tooltip on this icon reads: Dirty flag on EOB/ELE indicates that the claim has charge codes that need to be corrected. When the Claim is posted, the Dirty Flag icon gets removed from beside the Charge Code but remains beside Remittance No and Claim Id but when the Voucher is posted, then the Dirty Flag icon gets removed from beside Remittance No, Claim Id and Charge Code.
Back to Top
Action Buttons
save button:
Clicking on this button the remittance voucher
will get saved. This button is enabled only when any change is made in the
EOB screen.
delete button:
Clicking on this button the remittance can be deleted.The button
is enabled only when the EOB is in 'Entered' status. It remains disabled for billed
vouchers.
reset button: Clicking on this button resets the unsaved data.
re-open button: Clicking on this button re-opens the voucher.
This button is enabled only when the EOB is in 'Posted' status. After
re-opening the voucher, the Status of the voucher is changed to Reopened
Status. And, also Archived entries can be seen on clicking the icon List of
reopened ERAs.
Ability To Unpost All Posted Claims From EOB
PrognoCIS supports Reason field on reopening the Claim. Property ts.eob.reopen.unpostclaims is introduced. This is a system level property. By default property will be set to ‘N’. If this property is set to ‘Y’ then Total Claims ie no of claims in EOB and checkbox UnPost All Claims with No Further Transactions is available. On click of this checkbox, user can unpost all Claims having no further transaction.
Admin button: Clicking on this button invokes the popup which List Claim Info.
This helps users to search for a specific claim on the EOB
and Option to recomputed all claims on all Claims present on selected voucher.
Note: Only Support Admin users or PrognoCIS internal support users have rights to use Admin button on EOB.Back to Top
Error Messages List
Validations are the error messages on closing the accordion and posting the voucher. Following are the list of validations which are performed on saving the accordion details.Error Message |
Comments |
Fix |
Type |
|---|---|---|---|
| Negative Balance Amount | If the balance amount for any of the charges is negative amount then on close of the accordion or on click of another claim row an error message saying ‘Error Line No:1 Code: XXXXX Negative Balance Amount’ is displayed. | User will have to remove the negative amount found in the EOB and add appropriate values | Claim Level Validation |
| Woff for Denied | If charges marked denied and the charge code is also written off using the write off button on the charges row then error message saying ‘Error Line No:1 Code: XXXXX Woff for Denied' is displayed. | If charges marked denied and the charge code is also written off using the write off button on the charges row then error message saying ‘Error Line No:1 Code: XXXXX Woff for Denied' is displayed. | If charges marked denied and the charge code is also written off using the write off button on the charges row then error message saying ‘Error Line No:1 Code: XXXXX Woff for Denied' is displayed. |
| Woff for Duplicate. | If charges marked are duplicate and are also written off using write off button then an error message saying ‘Error Line No:1 Code: XXXXX Woff for Duplicate’ is displayed. | If charges marked are duplicate and are also written off using write off button then an error message saying ‘Error Line No:1 Code: XXXXX Woff for Duplicate’ is displayed. | Claim Level Validation |
| Woff & Excess Amount are not supported on same charge row | Woff & Excess Amount are not supported on same charge row | User will have to remove the Write off amount or the Excess amount from the charge code in that EOB. | Claim Level Validation |
| Please define reason for Denial. | If Status ‘Approved’ is changed to Denied and the accordion is closed then message saying ‘Error Line No: X Code: XXXXX Denied No Reason’ is displayed. | User will have to select Denied Reason from the drop down to avoid the error message on save of the claim. | Claim Level Validation |
| Excess Amount collected with Balance Amount | If the Allowed amt is 100 and the Paid amt is 80 and the Balance amt is not paid and Excess amt is collected as 10 $ then on save message ‘Error Line No 1: Code XXXX Excess Amount collected with Balance Amount’ is displayed. | User will have to remove the balance amount or Allocate the Balance Amt in CoIns, Copay or Not Cov bucket | User will have to remove the balance amount or Allocate the Balance Amt in CoIns, Copay or Not Cov bucket |
| For Additional Payment, Next responsible amount is NOT ALLOWED. | Consider a scenario, where the Allowed Amount is 100 and suppose Paid amt is 80. Now if there is next responsibility present and there is an Additional Payment then on save message’ Error Line No 1: Code: XXXX For Additional Payment, Next responsible amount is NOT ALLOWED’ is displayed. | Next Responsibility and Additional Payment do not work together. User has to remove the next the responsibility or not enter the next responsibility to avoid the error message. | Claim Level Validation |
| To Delete entire claim, please use Delete Icon for Highlighted claim. | If all the charges are marked for deletion then on save an error message is displayed | If all the charges are marked for deletion then on save an error message is displayed | Voucher Level Validation |
| Payor is Mandatory | Consider a scenario where user has created EOB using the Add button and Payor field is not entered or selected. When user tries to save the EOB using the save button then message ‘Payor is mandatory’ is displayed. | User has to select or enter the Payor Name. | Voucher Level Validation |
| Remittance Date is mandatory | By default, system considers todays date as the Remittance Date. In an EOB, when the Remittance Date is kept blank and user tries to save the EOB using the save button then message ‘Remittance Date is mandatory’ is displayed. | Remittance Date cannot be future date | Voucher Level Validation |
| Amt is not valid | When other number was entered in Check Amt field then on save message 'Amt is NOT valid' is displayed. | Enter numeric values in Check Amt field. | Voucher Level Validation |
| Batch No is mandatory. | When the batch property billing.use.receipt.batchno is turned ‘ON’ and the Batch no is not selected from the Batch No field dropdown. Now when user tries to save the EOB using the save button, message ‘Batch No is mandatory’ is displayed. | User has to select the Batch no from the drop down. Batch No is mandatory when the property billing.use.receipt.batchno is ‘ON’. | Voucher Level Validation |
| Remittance Date cannot be greater than Batch Open Date. | Consider an EOB, the batch no is selected from the drop down and the receipt batch is not closed i.e. the batch is kept Open. Remittance Date can be changed or by default system considers todays date. Now, when user tries to save the claim then message ‘Year can not be more than:2017’ is displayed. | User has to set the Remittance Date as Batch Open Date then it allows to Post the EOB. | Voucher Level Validation |
| Remittance Date greater than today`s date. | When the Remittance Date is entered greater than Todays Date then on saving the EOB, message ‘Remittance Date greater than Todays Date’ is displayed. | User has to select the Remittance Date less than Todays Date. | Voucher Level Validation |
| Receipt Date cannot be greater than today. | Receipt Date field is enabled only when Pay Mode ‘Credit Card’ and ‘Electronic/EFT’. If the Receipt Date is selected more than Todays Date then error message ‘Receipt Date cannot be greater than Today’ is displayed. | User has to select the Receipt Date which is less than Todays Date | Voucher Level Validation |
| Check Date cannot be greater than today. | When the Check Date selected/entered is greater than Todays Date then on save message ‘Check Date cannot be greater than today’ is displayed. | Check Date cannot be Future Date | Voucher Level Validation |
| Check No. is mandatory | When the Check No field is kept blank and Pay Mode ‘Check’ is selected but the Check Amt field is present then error message is displayed. | Check No field is mandatory for the user to enter if Pay Mode option ‘Check’ is selected | Voucher Level Validation |
| Instrument No. is mandatory | When Pay Mode ‘Electronic/EFT’ and Check Amount is greater than zero and Instrument No is kept blank then on ‘save’, message ‘Instrument No. is mandatory’ is displayed. | Instrument No is mandatory. | Voucher Level Validation |
| Cannot Post Remittance with Non-Zero Remaining Amount. | If Property era.remittance.useadvance is set to N and the Check Amount is 0 or more than Allocated Amt or less than Allocated Amt then on save message ‘Cannot Post Remittance with Non- Zero Remaining Amount’ is displayed. | User has to enter the Paid amt mentioned in the check amount. | Voucher Level Validation |
| Cannot post failed Pay Pros Transaction/Integrity Transaction failed | If Payment gateway transaction is failed and if Payment gateway is PayPros then 'Cannot post failed PayPros Transaction' is displayed. If payment gateway is Integrity and Payment gateway transaction is failed then 'Cannot post failed Integrity Transaction' is displayed. | User needs to make Successful payment gateway transaction to avoid error message. | Voucher Level Validation |
| $XXX will be moved to Advance on Post. Continue? | Property era.remittance.useadvance is ON. Now, if the Check Amt is greater than the Paid Amt then on save the message ‘$XXX will be moved to Advance on Post. Continue? is displayed. | When the user clicks on yes button, then the amt moves to Advance bucket of the Patient. | Voucher Level Validation |
| Cannot Post. Remaining Amount Must be 0 | When the remaining amount is greater than 0 and the user does not move that amount to advance then 'Cannot Post. Remaining Amount Must be 0' is displayed. | User has to keep the Remaining amt as ‘0’. | Voucher Level Validation |
| $XXX will be used from Advance on Post. Continue? | If selected Payor does not have Advance Amt than following msg 'Allocated Amt greater than Receipt Plus Advance.' is displayed. If selected Payor has Advance Amt then message ‘$00.00 will be used from Advance on Post. Continue? is displayed. | Allow user to move the amount to advance. | Voucher Level Validation |
| Allocated Amt greater than Receipt Plus Advance. | For this scenario, property era.remittance.useadvance must be set to ‘F’. In an and EOB select the Claim. Associate Allocate Paid Amt and Coins Amt and select the Batch No. Now, enter Check Amt more than Allocated Amt and save, the message 'Allocated Amt greater than Receipt Plus Advance' is displayed. | User will have to enter check amount to avoid such message. | Voucher Level Validation |
Action Buttons:
save button: It saves the changes on Remittance screen.
delete button: It deletes the selected Remittance screen.
reset button: It resets any changes carried out on Remittance screen.
re-open button: It re-opens the Remittance which was in Posted
state.
history button: Clicking this button invokes EOB/ERA Screen History popup to check the last modifications done on the Remittance screen.Back To Top