Sometimes you bill one amount to the insurer, but the amount paid is less than what you billed.
This might be because the client’s coverage changed, or they maxed out their plan, or there was a clerical error, or one of the many, many, other reasons that insurance billing can be a bit complicated!
Our new, New Payment workflow, has been designed to make this process of receiving underpaid insurance claims a lot easier!
How to apply a bulk insurance check to multiple claims - when some of those claims are underpaid
First, you’re going to want to head to Billing > Insurer Invoices, and then pick the insurer that has sent you a payment.
Here, you can Filter for Submitted claims and click New Payment:
This will open the first New Payment screen where you can choose the method of payment, in this example, we’ll be receiving payment for our clinic The Village by cheque from Blue Cross/Blue Shield:
We’ll enter a bulk payment of $500 and click Next.
A new screen pops up where we see the $500 available to apply, and if you click “View All”, all of the outstanding, submitted claims from Blue Cross/Blue Shield generate in a list at the bottom:
For the claims that are paid in full, check the amount and then click “Apply”. But for the claims that are underpaid, leave it underpaid for now:
Jane will then keep a tally of each type of claim, and then you can make a note to go back in later and fix it to the amount that was actually paid:
You can then search for the next patient and keep working down your large payment, skipping the underpaid invoices in the same way you did before. Jane will keep a running tally of what you have applied so far in that top section.
If you want to head out and fix the underpayments you will then have the remainder of that payment waiting to apply and you can jump back in and keep going with the invoices that are left to pay off (and you’ve now fixed to be the lower amount).
How to account for the amount that you weren’t paid
When you are underpaid there are also two scenarios for what to do with the amount that should have been paid - the first is that you want to bill the amount that was not paid by the insurance company to the patient, the second is you want to write off the unpaid amount and not collect at all.
Go to Billing > Claims Submissions > Partially Paid
Here, Jane is keeping a list of partially paid claims that you can deal with.
Billing Unpaid Amount Back to Patient
If there is a user fee or gap payment you’d like to see covered by the patient, you can enter this amount into the User Fee field:
- *Please note that Jane will inherit the tax settings from the treatment. If your treatments are taxable, set the pre-taxed amount to be billed to the patient.
Writing Off the Unpaid Amount - Changing the Eligible Amount
When you’ve billed more than what’s paid, we call the paid portion the Eligible Amount.
In Billing > Claim Submissions in the Submitted Area.
Click on the arrow to the far right of the claim and select View Purchase:
If you prefer working from a single patient’s profile, you can get to the same area under Patients > Billing > Purchases and click the View button to open the purchase:
In the Purchase window that opens, scroll down to the Insurance section. Here you can set the Eligible Amount field to the amount being paid by insurance:
Help! I can’t edit the Eligible Amount
If your insurance claim is greyed out and unresponsive, chances are you can’t get past the first step of editing the eligible amount.
There are couple of reasons you wouldn’t be able to modify the insurance claim:
Payments Applied Jane will not allow you to modify claims with payments applied, so first Unapply any payments applied to the insurance claim. Unapplying an Insurance Payment
Grouped Invoices If you had grouped together multiple invoices before submitting them to insurance, you will need to ungroup them to make any changes. You can follow these steps for grouping and ungrouping invoices: Grouping and Ungrouping Invoices
If you’re having any other workflows you’re trying to act out, or have questions not answered by the guide don’t hesitate to reach out to us at firstname.lastname@example.org