Assume that, in this morning’s mail, you receive a check for $278.80 from the Aetna insurance company/Baltimore City Police plan. The check number is 1234; the bank number is 4321. The EOB (Explanation of Benefits) identifies the following allocations:
Patient A—$63.00
Patient B—$159.00
Patient C—$56.80
To process this bulk payment check:
Select Insurance > Insurance Payments. The Insurance Check Info window is displayed.
Type the following data in these fields:
Company—2 Aetna
Code—2 Insurance Payment
Amount—$278.80
Check No—1234
Bank No—4321
Click OK. The Insurance Payments window is displayed, with the data that you entered.
Click Load Claims. All outstanding claims for this company are displayed.
The top right of the window shows that $1002.20 is remaining to be paid because you have not received payment for claims #201, #1604, #1302, and #401. Therefore, select those claims, and click Remove. The four claims are removed from the list.
Click Post. The Bluebook Update Method window is displayed.
Because the amount of the insurance payment is exactly what the software estimated, there is no need to update the Bluebook, so click OK.
When you are asked to print batched billing statements, click Yes. The Output Options window is displayed.
Click OK. The Single Billing Statement Setup window is displayed.
To accept the defaults, click OK. The statement is printed, and a blank Insurance Payments window is displayed.
Click Close. A message is displayed.
Click Yes.
You have received a check in the mail from Aetna for $327.50. The check is the final payment for a claim made on behalf of a patient who works for United Parcel Service. The check number is 1236; the bank number is 4321.
Process this check, and print a statement to mail to the patient. For this exercise, do not update the Bluebook.
To process this check:
Select List > Patient. The Patient List window is displayed.
Select Patrick Arnold from the list.
Click Transactions on the toolbar. The Transactions List window is displayed.
Click Payments in the Options section of the Express bar. The Payments window is displayed.
Select the Insurance option. The Payments - Insurance Payment window is displayed.
Use the following values in these fields:
Code—Defaults to 2 insurance payment.
Amount—Defaults to $327.50.
Date—Defaults to today’s date.
Claim—Defaults to 11.
Final—Select
Check #—1236
Bank #—4321
Click Post. You are asked if you want to update the Bluebook.
Click No. You are asked if you want to send a billing statement for the account balance of $352.50.
Click Yes. You are asked if you want to print the statement.
Click Yes. The Output Options window is displayed.
Click OK. The Single Billing Statement Setup window is displayed.
Make your selections, and click OK. The Payments window is displayed.
Click Close. The Transactions window is displayed, and the payment of $327.50 that you posted is the most recent transaction.
Click Close. The Insurance Copay window is displayed.
Click Post Copay LATER. The Processing Options window is displayed.
Click Cancel, and click No when asked if you want to add a lab case.
You receive a payment from BlueCross/BlueShield for $248.50 against a claim made for a patient, Dan Thomas. This is not the amount that you were expecting the insurance company to pay. Process the claim, and update the Bluebook.
To process this claim:
Select Insurance > Insurance Payments. The Insurance Check Info window is displayed.
Select Blue Cross and Blue Shield of New Jersey from the Company drop-down list. Type $248.50 in the Amount field. Select Print Secondary Claims.
Click OK. The Insurance Payments window is displayed.
Click Add. The Patient List window is displayed.
Type THO in the Find field.
Double-click the patient’s name in the list. The Claim List window is displayed.
Double-click the claim for which the check was received. There is only one claim that was submitted for Dan Thomas, so double-click it. The Insurance Payments window is displayed.
The expected payment from insurance was $377.60, but the actual payment was only $248.50. Therefore, click Edit Distributions. The window is displayed in Edit mode.
Type the amount of the check in the Payment field, and click OK. The toolbar is activated.
Click Post. The Bluebook Update Method window is displayed.
Type 1 in the Bluebook Update Method field, and click OK. The Update Bluebook Entry window is displayed.
Click Edit. The window is displayed in Edit mode. Make the following changes:
Select Chg to indicate that a change has occurred.
Type $248.50 in the Paid column (the amount that the insurance company allowed).
Type 50 in the % column (the percentage that the company paid).
Click OK.
Click Close. The Claims Submitted to Secondary Carrier window is displayed.
Click OK. You are asked to print batched billing statements.
Select Yes, and click OK. The Insurance Payments window is displayed, but now it is blank.
Click Close. You are asked if you want to exit insurance payments.
Click Yes.
Posting Payments from Patients
Posting Payments from Insurance Companies