Match Insurance Payments

Most ERA payments coming into Avea are automatically matched, but for some, additional steps are required. When electronic payments are transmitted, sometimes the payer does not include full information or it’s necessary to add data to complete records. Mapping and matching will be used interchangeably. Both terms refer to pairing an ERA with a patient and claim.

Why is matching insurance payments important?

Matching payments helps facilities realize their revenue. Payments waiting to be mapped represent money that needs to be linked to a claim. Even non-payments should be mapped to claims. Without having information on unmapped ERAs, a follow-up team will be operating without the most current information from the payer. Mapping payments can save time on follow-up calls or possibly eliminate the need to make a call. It takes more time to follow up on a claim and note payments or denial reasons than it does to map an ERA to a claim and review it.

Mapping Insurance Payments Video 

Mapping Payments

Use the instructions below to match payments to ERAs.

  1. Navigate to the Review Insurance Payments tab through one of the paths below.
    • Go to Work CenterInsurance PaymentsReview Insurance Paymentsmceclip0.png
    • Or, navigate to Management Center and click on the Insurance Payments in Review tile.mceclip5.png
  2. Select the Organization from the drop-down menu. Two stars (**) next to the organization's name indicates that payments are waiting to be mapped for that organization. mceclip1.png
  3. From this screen, EOBs can be viewed, marked as legacy, or resolved.mceclip2.png
  • Resolve: Click this link to add or update the payment information so the payment can be matched to a patient and claim in Avea. Each mapping situation is going to be slightly different depending on what information is missing.
  • Tip: When resolving a payment, it is helpful to open both the EOB and the patient’s claims page in separate tabs. This reduces the amount of searching, especially when mapping multiple claims for the same patient.
  • Mark as Legacy: This will send the payment to the Insurance Payments tab in the Records Center where it can later be viewed, referenced, or edited. Marking a payment as legacy means that the payment in question maps to a claim that is not in Avea's system. This is most likely to come up with claims submitted to payers before an organization began using Avea.
  • Note: If Legacy claims have previously been entered, Avea payments do not need to be marked as Legacy. Instead, those payments can be resolved and matched to claims.
  • View EOB: It is helpful to look at the payment sent over by the payer before deciding to Mark as Legacy or Resolve.
  • To match the payment, start by right-clicking on the View EOB link and opening it in a new tab. This allows you to view the EOB details while resolving the error. mceclip3.png
  • Then, click Resolve for that same EOB.
  • The Resolve Payment Review screen will open. This screen lets the poster know what information is needed to match the claim.mceclip1.png
    • Example: In the above image, information about the patient was not found so this selection must be made manually. After a patient is selected choose the Claim Instance and Service.
  • Review the EOB and use the EOB information to enter any missing fields in the order they appear in the Resolve Payment Review window. The system will only display patients in the menu that attended the selected practice and have insurance from the listed payer. Once a patient is chosen, only claims for that patient will be displayed. This feature narrows down the poster's options and reduces human error.
  • Practice: Select the practice where the treatment was rendered.
  • Payer*: Select the payer listed on the EOB.
  • Patient: Select the patient listed on the EOB.
    • Override Payer: Sometimes claims are submitted to one payer and the EOB is returned from a different payer. If this occurs, the patient will not appear in the payer list after the practice and payer are selected. To resolve click, Patient not listed? Override Payer to select patient. The payer is the insurance company listed on the EOB. The override payer is where the claim was submitted.
    • Example: An EOB is returned from OptumHealth but the patient’s claims were submitted to UMR. When this happens, the system will preselect OptumHealth. This prevents automatic matching because the patient is only associated with UMR. To resolve, the poster will override the original payer, UMR to enable patient selection.
  • Claim Instance: Select the claim number associated with the EOB in question.
  • Internal Control Number: This is the payer’s claim number. If the Internal Control Number does not populate, it can be located on the EOB.
  • Reconcile any imbalances denoted by red entries in Line Item Totals.mceclip0.png
    • Example: In the above image, the poster must enter the billed amount of $100 under the billed column for Line Item 1. They will also need to enter the patient responsibility amount of $100 under the Patient Responsibility column for the Payment Totals line.
  • Click Save.
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