Apply an Insurance Payment Manually - Primary
This section explains the steps involved in applying an insurance payment to a claim manually. This help page provides the steps involved in manually applying an insurance payment to a claim. An insurance payment can be applied from a patient’s chart, from the Charge Entry page, or from the Payments Overview page. This help page reviews the process from a patient’s chart.
Note: It is assumed that the payment has already been posted prior to beginning these steps.
Insurance Payment Search
Hover your cursor over (1) Billing and then click (2) Payments.
4. Enter/search for the Claim ID. The HF Claim ID is the patient’s account number on the EOB/ERA.
5. Enter the number and click Get.
Search – When the patient account number does not match the HF claim ID use the “Advanced
Claim Search” located next to the “Get” button.
Search by patient name, provider, payer, service date, created date, or charges.
Note: Only 1 search criteria is required.
Click claim ID under the payer column (as seen below).
Basic Adjudication
1. Enter Ins PMT
2. Enter Patient Responsibility in Copay (PR3), Co-Ins (PR2), and/or Other PR (defaults to
Deductible)
3. Enter Ins Adj (Defaults to a contractual adjustment – CO-45)
4. Click Post Payment
Note: The Insurance Balance Column has to be $0 for the payment to post correctly.
Advanced Adjudication
The claim processing status can be selected. If Denied is selected the claim will be available in
the Denied bucket on the Claim Status Dashboard.
Note: This is a defaulted value. Processed as Primary for Primary Claims and Processed as
Secondary for Secondary Claims
- The Expected Fee Schedule can be used to confirm the correct payment was received and autofill the allowed amount.
When the allowed amount is entered, tab out of the field and the Ins Adj will auto-fill. The formula used is Charge – Allowed = Ins Adj.
Note: The use of the allowed amount is NOT required
Links are available to Post at the Claim Level and Post Claim Level Adjustment (NOT
recommended)
Adjustment Categories can be changed to match what is on the EOB.
By default Other PR defaults to Deductible (PR1) and Ins Adj defaults to a Contractual Adjustment
(CO-45).
To edit these categories
1. Click the blue “Edit Adj” icon located under the Pat Bal column.
2. Click the edit icon next the adjustment category that needs to be edited.
3. The adjustment code on the EOB can be entered (example CO29). OR
4. Use the dropdown box for a pre-established list of options
5. Click “Save Adjustment”
Note: If a note is entered that note will export on the Production – Adjustment Reports.
Once the payment is posted successfully expand the “Claim Search” option to find the next claim
on the EOB that needs to be posted.