Insurance Payments – How to Enter
When an insurance payment is received, the payment is applied toward treatment and the remaining insurance benefit amounts are updated automatically. Distributing the insurance payment toward specific treatment is important since you can then go back at any time to view this payment and treatment on the Distribution Detail window.
You should also update the estimated insurance pending amount for each line of treatment at this time so that the insurance plan will be updated for the actual amount that the insurance pays for each treatment. In this way, future treatment will accurately reflect insurance estimated amounts. You will be given the option to update the insurance estimate to the coverage percentage or the maximum.
The Explanation of Benefits from the insurance company is used to update the insurance plan since it shows what was paid for each line of treatment.
Depending on your Office Setup, when an insurance company pays more than the estimated amount, you can distribute the remaining portion to the patient balance. You can also update remaining insurance benefits.
Linking an insurance payment to lines of treatment will stop it from tracking on the Past Due Insurance Claim Report.
Insurance payments are entered from the patient’s Transaction screen. They can also be entered directly from the Past Due Insurance Claim Report.
When you enter an insurance payment from the Transaction screen, you have two choices.
- You can enter the insurance payment code under the Code column by entering the insurance payment code.
- Or you can right click on the insurance claim line (CP-Sent to Blue Cross Blue Shield) and select Enter Insurance Payment from the popup menu. The claimed items will be listed at the bottom of this screen for reference.
The insurance payment line on the Transaction screen will show the insurance claim date of the treatment to which it is linked. The date is shown under the InsClm column. If the payment is linked to treatment that was claimed on different dates, the column will show the first date it finds.
You will also have the option to automatically distribute insurance payments by marking the box Auto-Distribute Insurance Payment at the bottom of the insurance payment distribution window. This will distribute a percentage of the insurance payment to each line of treatment.
In addition, insurance overpayments can be linked to patient or family portions due.
Mark the box to “Include Patient Balances” at the bottom of the insurance distribution window if you want to include treatment with zero insurance estimates. This would allow you to link insurance payments to treatment with zero estimated insurance, as well as update the insurance plan.
Tip: Enter a Y in the cursor movement and the Fee window will automatically open for you to enter the amount of the insurance payment.
If you receive a bulk insurance check from the insurance company, you can distribute it to anyone who has the same insurance company. The Bulk Insurance Payment feature is under Go To on the menu bar on the Patient Lookup List or from any Transaction screen.
Tip: The Insurance Payment Summary Report includes primary and secondary insurance payment totals by insurance company. You can also include totals for group plans, as well as patient names and totals for patients.