Payment can be posted using the 'Post Payment' action item against the claim. The Post Payment view displays the payment summary as shown below.
After receiving EOB from the payer, payments can be applied using the 'Add New Payment' link at the top right of the payment summary dialog. Added payment will be applied to the corresponding invoice in EHR if 'Apply payments to invoice' is checked.
Payment History can be viewed by clicking the 'Show History' link in the bottom left corner of the Payment Summary dialog. The latest payment can be edited or deleted.
On applying EOB to the claim, claim status will change based on the payment, adjustment, patient responsibility and denial as explained in the below table.
| Claim Status | Description |
|---|---|
| Paid | The claim has been paid by the insurance company without any due. It may have adjustments and patient responsibilities. |
| Partially Paid | Received partial payment from the insurance company. |
| Closed-PR | Claim closed with patient responsibility and without any payment. It may have adjustments. |
| Closed-Adjustment | Claim completely closed only with contractual adjustment. |
| UnPaid | Claim with no payment. May have patient responsibility or adjustment. Claim still has due. |
| Denial | All the CPTs of the claim, denied by Payer. |
While applying Payments, if a CPT is denied in EOB, that CPT can be marked as denied using the 'Denied' checkbox available at the rightmost corner of the line item. On marking CPT as denied, fields for entering denial code, type and comment will appear.
When a claim is denied by the payer, it will be reworked by the RCM Team before resubmitting the claim. Claims are corrected by adding Code 7 (Resubmission code) and original reference number in Box 22 of CMS 1500 form, which is located in the fourth step of the claim wizard. Claims that are resubmitted without an original reference number will be denied as duplicate by the payer.
