You have submitted your claims in Jane and a couple of weeks have gone by – now insurance companies are mailing you cheques along with paper EOBs. Not sure how to record these payments in Jane? Continue reading!
This guide helps walk you through how to record an EOB that you have received in the mail. If you have enrolled for electronic remittances, please refer to this guide on how to record these payments: Posting Insurer Payments With Electronic Remittances (ERAs)
📖 EOB stands for Explanation of Benefits: This is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf.
Posting an Insurer Underpayment - Example
For our example, let’s say we treat Keith and bill out two codes:
1) 99354 - with a fee of $100
2) 99204 - with a fee of $150
Additionally, at the time of service, we collect a $20 co-pay.
As per usual, we will mark the appointment as Arrived and collect any needed patient responsibility at the time of service. Let’s fast forward a couple of weeks after we’ve submitted this claim and say that we’ve received an EOB for this visit.
Your EOB will include several pieces of information for each billing code regarding the claim:
- Billed Amount
- Allowed Amount (a contracted rate if you are in-network with the insurer)
- Paid Amount (from insurance)
- Patient Copay
- Patient Coinsurance
- Patient Deductible
You will need this information to accurately record the payment in Jane.
Now that you have the paper EOBs in front of you, you’ll want to head over to your Billing tab and begin recording and posting these payments. 💸
1. Record the Insurer Payment
- Head to Billing and click on the Insurer who provided the cheque
- Click on New Payment
- Enter in the necessary details regarding the payment: Location, Payment Method, Reference Number, Amount, and Received At Date
- Click Next to record the payment in Jane
You have now recorded a payment for that specific insurer and it is sitting as a credit ready to be applied to the correct visits.
2. Apply Payment to Corresponding Dates of Service
From here, you will need to locate each date of service that came in your paper EOB. In most cases, the insurance company will organize these in order by the patient. In our example, we can search “Keith Rice” and locate the date of service we need to record.
- In the search box, search for the patient’s name or invoice number
- Once you locate the correct date of service, click Edit to record the payment in detail
- Next, you will need to manually enter the values that are listed on your paper EOB into the corresponding boxes for each billing code
- Once all of the information is entered, click Apply Changes
Voila! The claim is now considered Paid and Approved. 🎉
The balance of the insurer payment will continue to go down as you apply it to different claims, you can do this until you reach $0.
Note: Sometimes, insurance policies change and amounts come back that we don’t expect. It happens! Let’s say that Keith’s insurance came back and said his copay was actually $30, instead of $20. You would enter $30 in the copay box and Jane would generate a balance of the difference owing on his account, so in Keith’s case $10.
In case you ever run into any unique scenarios in your EOB, such as overpayment recovery or a reversal of a previous payment, you can check out this guide here on the steps to accurately record this in Jane: How do I reconcile insurance claim reversals?