Understanding the ePostings Payment Detail Window

The ePostings Payment Detail window contains the following fields:

• Patient:

  Displays the patient last name, first name, and middle initial.

  If the line item is for a provider adjustment, there is no associated patient, and **Provider Adj** is displayed.

• Guarantor:

  Displays the Guarantor for the patient.

  If the line item is for a provider adjustment, this column is blank.

• From:

  Displays the start Date of Service for the claim.

  If the line item is for a provider adjustment, the column displays //.

• To:

  Displays the end Date of Service for the claim.

  If the line item is for a provider adjustment, this column displays //.

• Clm Amt:

  Displays the total amount of the individual claim.

  If the line item is for a provider adjustment, this column displays 0.00.

• Payment:

  Displays the total payment for the individual claim.

  If the line item is for a Provider Adjustment, this is the amount of the adjustment.

• Pat Amt:

  Displays the portion of this claim's total claim amount that is the patient's responsibility.

  If the line item is for a provider adjustment, this column displays 0.00.

• WO Amt:

  Displays the write-off amount for the claim.

  If the line item is for a provider adjustment, this column displays 0.00.

• Other Amt:

  Displays the portion of this claim's total claim amount that the software cannot assign to Patient Responsibility, Write Off, or Other Insurance.

  If a total is displayed in this field, you must manually distribute the adjustment amount.

• Claim ID:

  Displays the claim ID of the SoftDent claim associated with the ePostings payment.

  If the line item is for a claim that has not yet been matched to a SoftDent claim, this column displays NEED.

  If the line item is for a provider adjustment, the column displays N/A.

• Status:

  Displays the following codes:

  Need Claim:

  Click Need Claim to display a menu to help you associate the claim.

  Confirm Clm:

  Click Confirm Claim to display a menu to help you confirm the claim.

  Verify Distrib:

  Click Verify Distrib to display a menu to help you accept or edit the distribution.

  Manual Distrib:

  Click Manual Distrib to display a menu to help you edit and accept the distribution.

  Ready:

  The claim amounts match, and no further action must be taken. When all claims have a Ready status, you can post the payment.

  Denied:

  The claim has been denied by the insurance company. See the Distribution Reasons section at the bottom of the window for an explanation.

  Pre Auth:

  The claim is a pre-authorization. No payment is made.

  Reversal:

  The amount is a reversal.

  Not Postable:

  The amount is not postable.

  Already Posted:

  The claim has already been posted.

• Final:

  Check this box to indicate that the ePostings payment associated with this claim is a final payment for that claim.  All Final statuses receive a check by default.

  All Denied statuses receive a check by default and cannot be changed.

  • If all transactions can be matched to the ePostings payment for that claim, the Final checkbox is selected by default. You should confirm the transactions and deselect the checkbox, if necessary.

• Hold:

  Check this box to prevent claims that are otherwise ready for posting from being processed. Initially, all ePostings claim-level entries have a hold status of OFF, and the checkbox is not selected.

  If you click on the checkbox of an ePostings claim-level entry that is not on hold, the claim's hold status is set to ON, and the entry moves to the bottom of the list.  

  As long as one associated claim is on hold, the ePostings payment associated with this claim is also on hold.

  If you click on the checkbox of an ePostings claim-level entry that is on hold, the claim's hold status is set to OFF, and the entry moves back to its proper place in the current sort order.

  When no associated claims are on hold, the ePostings payment associated with this claim is no longer on hold.

  • For any sort option chosen, the ePostings records on hold are displayed at the bottom of the list and are sorted by the selected option.

• Distribution Status:

  Displays the status of the match between the SoftDent estimation and the ePostings recommended adjustments.

SoftDent Side

• Claim #:

  The claim number from the SoftDent database and the type of insurance: primary (Prim) or secondary (Sec).

• Patient ID:

  The patient ID from the SoftDent database.

• Claim Total:

  The actual claim total amount of the claim from the SoftDent claim database.

  • If the SoftDent claim total does not match the ePostings claim total, the total is displayed in red.

• Claim Date:

  The start date of service of the claim from the SoftDent claim database.

• Code Submitted:

  The procedure code assigned to this transaction from the SoftDent database.

• T#:

  The tooth number of the matching transaction in the SoftDent database.

  The tooth number is displayed in one of the following ways:

  • Blank—The field is blank if the SoftDent transaction does not have an associated tooth.

  • ##—The field contains the two-digit tooth number (or single letter) of the SoftDent transaction that has been matched to the ePostings line item by the Transaction ID.

  • *##—The field contains the two-digit tooth number (or single letter) of the SoftDent transaction preceded by an asterisk when the SoftDent transaction has been matched to the ePostings line item using the Submitted Code/Submitted Amount. This indicates a probable match.

• Amt Submitted:

  The amount submitted for this procedure from the SoftDent database.

• Expected Ins.:

  The expected insurance payment amount for the transaction from the SoftDent database.

• Expected Pat. Resp.:

  The amount the patient is expected to pay from the SoftDent database.

• Expected Writeoff:

  The amount of the expected writeoff from the SoftDent database.

• Expected Other Ins.:

  The expected secondary insurance amount from the SoftDent database.

ePostings Side

• Claim #:

  The claim number returned from the ePostings database and the type of insurance: primary (Prim) or secondary (Sec).

• Patient ID:

  The patient ID returned by the ePostings database.

• Claim Total:

  The claim total returned by the ePostings database.

  • If the ePostings claim total does not match the SoftDent claim total, the total is displayed in red.

• Claim Date:

  The start date of service returned from the ePostings database.

• Code Paid:

  The procedure code for which payment was received from the ePostings database.

• Amt Submitted:

  The amount submitted for this procedure from the ePostings database.

• Ins Paid:

  The amount paid for this procedure by the insurance company from the ePostings database.

• Pat Resp.:

  The amount for which the patient is responsible, returned from the ePostings database.

• Writeoff:

  The actual writeoff amount from the ePostings database.

• Other Ins Paid:

  The amount paid by secondary insurance from the ePostings database.

• Other Adjust:

  The other adjustment amount from the SoftDent database. This amount must be distributed to the Pat Resp. or Writeoff field before the payment can be posted.

• Update Bluebook:

  Selecting this checkbox updates the bluebook with the new amount.

  The checkbox is unchecked for the following reasons:

  • The claim is a secondary claim.

  • The fee used to calculate this transaction (fee on posted transaction) is different from the bluebook’s fee schedule 0 amount. (The fee used to estimate is different from the fee this bluebook entry is estimated from.)

  • The bluebook entry has a "T" tag. (It was created from Trojan.)

  • The bluebook entry has changed since the transaction posting. (The date on the bluebook entry is after the transaction’s posted date.)

  • A deductible might be involved (if the SoftDent transaction has a deductable amount on it).

  The checkbox is checked for the following reasons:

  • The claim is a primary claim, and none of the reasons above are present.

  If one of the above conditions exists and you select the Update Bluebook checkbox, the Bluebook window is displayed, stating the reason why you might not want to update the bluebook. Click OK to update.

Bottom of Window

• Posting Status:

  Displays the status of the selected entry and what you need to do before the payment can be posted.

• Distribution  Reasons:

  Displays an explanation for any amount that was not covered—when the amount paid does not equal the amount submitted.

  • If the claim has a claim-level adjustment and two or more collection doctors are associated with the claim, you must manually distribute the amount of the claim-level adjustment. For more information, see Using the Claim Adjustment Window.

Payment Transaction(s) to be Posted

• Code:

  The default payment code to be posted.

  • If the type of payment is a check, the code displayed by default is 2.92.

  • If the type of payment is an EFT, the code displayed by default is 2.93.

  • If the status of the highlighted claim is Not Postable, this field is blank.

  • You change the default code to any other code in the ADA database by using the Change Post Code option.

• Amount:

  The amount of the payment transaction to be posted.

  If the status of the highlighted claim is Not Postable, this field is blank.

  This field displays the amount of all the transactions for this claim that are associated with a single collections doctor.

  The collections doctor (Dr$) displayed first is the collections doctor for the first transaction in the list. The Paid Amts of all transactions in the list that have this collections doctor are added and displayed in this field.

  If claim-level adjustments were distributed to this Dr$, this value is adjusted accordingly.

• Dr$:

  This field displays the ID of the collections doctor associated with the payment.

  The collections doctor ID displayed first is the ID of the collections doctor for the first transaction in the list.

• Code Dr$2:

  If the claim has transactions that contain more than one collections doctor, an additional payment entry is displayed to the right of the first one.

  If the type of payment is a check, the code displayed by default is 2.92.

  If the type of payment is an EFT, the code displayed by default is 2.93.

  If the status of the highlighted claim is Not Postable, this field is blank.

• Amount Dr$2:

  The amount of the payment transaction for the second collections doctor to be posted is displayed to the right of the first payment code info.

  If the status of the highlighted claim is Not Postable, this field is blank.

  This field displays the amount of all transactions for this claim that are associated with an additional collections doctor.

  The collections doctor (Dr$) to be displayed will be the second collections doctor for a transaction in the list.

  The Paid Amts of all transactions in the list that have this collections doctor are added and displayed in this field.

  If claim-level adjustments were manually distributed to this Dr$, this value is adjusted accordingly.

• Dr$2:

  The ID of the collections doctor stored with the second payment transaction to be posted is displayed to the right of the first payment info.

  If the status of the highlighted claim is Not Postable, this field is blank.

  This field displays the ID of the additional collections doctor associated with the payment.

  The collections doctor ID to be displayed is the ID of the second collections doctor for any transaction in the list.

• Notes Icon:

  A small icon   is displayed in the upper right-hand corner of the comparison section if the ePostings payment has a note. You can float over the icon with your mouse to view the note. Click the icon to open the ePostings Notes window and view existing notes or add a new note.

• Payment Transaction Note Icon:

  A small icon   is displayed in the Payment Transaction section. If the ePostings payment has a note, you can float over the icon with your mouse to view the note. Click the icon to open the Payment Transaction Note window, where you can edit an existing note or create a note.

• Post All:

  Select this option to post one or more payments and/or adjustments for all claims associated with the ePostings payment.

  • The claims must have  a status of Ready, Confirmed, or Not Postable. None of the entries can be On Hold, and the Payment Date cannot be in the future.

  • To use this function, you must have Add Transaction security permissions. You can also assign a Login or Password Override to this function.

   

   

• Change Post Code:

  Select this option to display the ePostings - Change Post Code window, which enables you to change the currently selected posting code to a new code. Select the new code from the list and click OK.

• Edit/View Payment Note:

  Select this option to display the Payment Transaction Note window, which enables you to add or edit a payment transaction note for this claim.

  • Clicking the Payment Transaction Note icon  displays this window as well.

• Need Claim:

  Selecting this option displays the following menu:

  • Associate with Claim—Select this option to open the Claim list, and double-click the correct claim.

  • Associate with Completed Claim—Select this option to open the Completed Claim list, and double-click the correct claim.

  • Mark Not Postable—This option can be used in cases when the check or EFT sent to an office contains payment for more than just that office. Selecting this option displays a warning stating that this will cause the Posted amount to be different than the actual check amount.
     

  • This option should be used only by the person who regularly handles ePostings payments.

   

• Confirm Claim:

  Selecting this option displays the following menu:

  • Confirm Claim—After viewing the claim information, select this option to confirm that this is the correct claim.

  • View Associated Claim—Select this option to open the Claim window and view the claim information.

  • Associate with Claim—Select this option to open the Claim list, and double-click the correct claim.

  • Associate with Completed Claim—Select this option to open the Completed Claim list, and double-click the correct claim.

  • Mark Not Postable—This option can be used in cases when the check or EFT sent to an office contains payment for more than just that office. Selecting this option displays a warning stating that this will cause the Posted amount to be different than the actual check amount.
     

  • This option should be used only by the person who regularly handles ePostings payments.

   

• Verify Distribution:

  Selecting this option displays the following menu:

  • Accept Distribution—After verifying all adjustment reasons, select this option to confirm that the SoftDent estimation did not match the actual ePostings distribution.

  • Edit Distribution—Select this option to display the ePostings Claim Detail window, and make changes to the totals in the Pat Resp. and Writeoff columns.

   

• Manual Distribution:

  Selecting this option displays the following menu:

  • Edit Distribution—Select this option to display the ePostings Claim Detail window, and make changes to the totals in the Pat Resp. and Writeoff columns.

  • Accept Distribution—Select this option to indicate that the reasons provided are acceptable and that the distributions should take place based on the original reason codes. A warning message is displayed, asking if you are sure this is what you want to do.

   

• View Associated Claim:

  Select this option to open the Claim window and view the claim information.

• Disassociate from Claim:

  Select this option if you have made a mistake and associated the claim incorrectly.

  This option is enabled when a claim has a status of Ready, Verify Distrib, or Manual Distrib.

  When you select this option, the Claim ID field of the selected claim is set to NEED, and the Claim Status field is changed to Need Claim.

• Edit Distribution:

  Select this option to display the ePostings Claim Detail window, and make changes to the totals in the Pat Resp. and Writeoff columns.

  • This option is enabled based on the user's security rights:

  • The Edit Distribution option is enabled if System Security has not been turned on.

  • If System Security has been turned on, you must have Modify Transactions security permissions to use the Edit Distribution option.

  • The Edit Distribution option is also enabled if the user does not have access but the feature has been assigned a Login or Password Override.

   

   

• Mark Not Postable:

  Select this option to mark a claim as Not Postable.

  When you select this option, a warning is displayed, stating that marking the claim as Not Postable will cause the Posted amount to be different from the actual check amount.

  This option can be used in cases when the check or EFT sent to an office contains payment for more than just that office.

  • This option should be used only by the person who regularly handles ePostings payments.

   

• Unmark Not Postable:

  Select this option to undo a claim you have manually marked as Not Postable.

  • You cannot use this option if the claim status of Not Postable was set automatically by ePostings.

  If you select this option and the selected claim had a claim associated with it before you marked it as Not Postable, the claim status is changed to Confirm Claim.

  If the selected claim did not have a claim associated with it, the claim status is changed to Need Claim.

• View/Add Notes:

  Select this option to display the ePostings - View/Add Notes window, where you can view existing notes or add notes associated with the selected ePostings payment.

• View Original ePostings Data:

  Select this option to display the ePostings payment data for the selected claim as it was received from the clearinghouse.

• Documents:

  Select this option to display the Documents window for this claim. See Viewing ePostings Documents in the Document Manager for more information.

• Review:

  Select this option to display the Document Review window for the selected ePostings payment.

• View Patient Information:

  Select this option to display the Patient window for the patient associated with this claim.

• View Plan Information:

  Select this option to view the Insurance Plan window for the insurance plan associated with this claim.

• 1 Add Memo:

  Select this option to display the Memos window, where you can type a memo concerning the selected claim. This memo is displayed in the Today's Memos window.

• 2 View Bluebook:

  Select this option to display the Bluebook window for the selected transaction code. You can view or update the bluebook entry.

• Right-click on the transaction on the SoftDent side to display a drop-down menu, and select Start Link.

• Right-click on the corresponding transaction on the ePostings side, and select Complete Link.

A claim has a status of Confirm Claim.

1. Click Confirm Claim. An option menu is displayed.

2. Select View Associated Claim. The Claim window is displayed.

3. Verify that this is the correct information and click Close.

4. Click Confirm Claim. The status has changed to Verify Distribution.

5. Click Verify Distribution and do one of the following:

6. To edit the distribution, select Edit Distribution. The ePostings Claim Detail window is displayed.

7. Make the changes in the Pat Resp and Writeoff fields and click OK. The status changes to Ready.

 OR

• If the distribution is correct, click Accept Distribution. The status changes to Ready.

A claim has a status of Need Claim.

1. Click Need Claim. An option menu is displayed.

2. Select Associate with Claim. The Claim window is displayed.

3. Find the matching claim in the list and double-click the claim. The status has changed to Manual Distrib.

4. Click Manual Distrib and do one of the following:

5. To edit the distribution, select Edit Distribution. The ePostings Claim Detail window is displayed.

6. Make the changes in the Pat Resp and Writeoff fields and click OK. The status changes to Ready.

 OR

• If the distribution is correct, click Accept Distribution. The status changes to Ready.