The Claim Payments Report includes all insurance payments recorded within a specific date range, viewable in either a summary or detailed format. Reviewing the revenue for an Organization or Managing Organization provides valuable insight into collections and the cash flow of the revenue cycle.
Generating the Report
Let's review how to create the Claim Payments report!
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- Navigate to the Reporting section.
- Under Billing Reports, select Claim Payments Report.
- Update the filters to instruct the system on how to generate the report.
- Select Run Report.
- To download the report, select Download.
- To include data from the last 24 hours, select Refresh Data.
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Available Filters and Definitions
The Claim Payments Report is customizable based on the Report Display desired. The Report Display tells the system how much information should be included for each payment by selecting either Summary or Detail.
- Summary will display payment information at the claim level, with all payment lines rolled up to the payment number.
- Detail will display the payment information at the payment level, with all payment lines broken out into individual line items. Selecting Detail will add additional filters that can be used to further refine the report.
Summary Display Filters and Definitions
- The Selected Practices filter allows users to filter search results based on the practice that claims were submitted under.
- The Date Type drives what payments will be included in the report within the timeframe established in the Start and End Date.
- Created - This field indicates the day the Payment Collection was created.
- Deposit - This field will only be recognized when a user has manually updated the deposit date within the Payment Collection.
- Payment - This field is derived from the Check Date selected with the Payment Collection.
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Post (Default) - This date is when the payment was applied to the claim.
- The Start Date and End Date instruct the system to include payments received within the set range.
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Payment Matching Status refers to where the payment exists in Avea.
- Matched Claim Payments(Default): This includes all payments matched to a claim(s).
- All Payments: This includes Matched Payment, Unmatched Payments, and Legacy Payments.
- Legacy Payments: This includes payments received for claims that did not originate from Avea.
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Unmatched Payments: This includes payments that must be manually matched in the Work Center > Insurance Payments > Payments in Review.
Detail Display Filters and Definitions
- The Selected Practices filter allows users to filter search results based on the practice that claims were submitted under.
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The Date Type drives what payments will be included in the report within the timeframe established in the Start and End Date.
- Deposit - This field will only be recognized when a user has manually updated the deposit date within the Payment Collection.
- Payment - This field is derived from the Check Date selected with the Payment Collection.
- Post (Default) - This date is when the payment was entered into the system.
- Service Start - This date is the first date of service listed of the line-item.
- Service End - This date is the last date of service listed on the line-item.
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Submitted - This is the day the claim was submitted to the clearinghouse. The submitted date will only show claims that have a submitted date within the date range selected.
- The Start Date and End Date instructs the system to include payments received within the set range.
- The Display Claim State instructs the system to include or omit claims based on their current A/R state.
- All (Default): All claims that fall within the date range and date type established will be included.
- Closed: This means the claim was closed during the date range set.
- Discontinued: This means the practice was deactivated during the life of the claim. If you have discontinued claims, please reach out to us at support@aveasolutions.com.
- Open: This means the claim was open during the date range set.
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Voided: This means the claim was voided during the date range set.
- The Payments Display filter instructs the system to include or omit claims based on whether a payment has been made against the claim.
- The Claim Status Date Type allows the user to choose whether they want to see a claim's status that is Currently assigned, or the status at the time of the Post or Payment date.
- Select Show Multi-Day Payments Only to summarize all payments by the claim itself as opposed to breaking down each payment line item per date of service.
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Payment Matching Status refers to where the payment exists in Avea.
- Matched Claim Payments(Default): This includes all payments matched to a claim(s).
- All Payments: This includes Matched Payment, Unmatched Payments, and Legacy Payments.
- Legacy Payments: This includes payments received for claims that did not originate from Avea.
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Unmatched Payments: This includes payments that must be manually matched in the Work Center > Insurance Payments > Payments in Review.
Viewing the Report
The data provided in the report will vary based on the Report Display selected. To view an example of a summary display, click here. To view an example of a detail display, click here.
- The Summary Display produces a table where each row represents a single claim payment in its entirety, and each column displays different details regarding that payment or non-payment. Dates of service, units, charge amounts, and paid amounts are consolidated into one row.
- The Detail Display produces a table where each row represents each payment line item, and each column contains information about that item. Dates of service, Units, Charge amounts and Paid amounts are broken out to a separate line. It's important to note that the Claim ID, Check Number and other data will repeat on each line.
Columns and Locations for Summary Display
| Row Name | Definition/Location |
| Payment Date, Post Date, Deposit Date, and Created Date. | Record Center > Insurance Payments > Payment Collections > Check Number |
| Organization and Practice. | Patient > Treatment Episode |
| Facility | Patient > Services |
| Patient Name and Patient ID. | Patient > Profile |
| Patient MRN | Patient > Treatment Episode > Intake > Patient Profile |
| Claim Payer and Claim ID. | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim |
| Sequence and Version. | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Instances |
| Service Start Date, Service End Date, Units, Service, Revenue Code, and Procedure Code. | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Instances > Control Number > Details > Line Items |
| Bill Type and Place of Service. | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Instances > Control Number > Details > Contents |
| Charges, Expected, and Covered Amount. | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim |
| Paid to Facility, Paid to Patient, Interest Paid, and Total Paid. | Record Center > Insurance Payments > Payment Collections > Check Number > Payment Collection > Payments > ICN |
| Payment Source, Payment Type, and Check Number. | Record Center > Insurance Payments > Payment Collections > Check Number |
| Payment Matching Status | Record Center > Insurance Payments > Payment Collections > Check Number > Payment Collection > Payments |
| Claim Source | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Instances > Control Number > Details |
| Single Case Agreement | Patient > Treatment Episode > Scheduling and Utilization > Service Rates |
| Rendering Provider | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Instances > Control Number > Details > Line Items |
Columns and Locations for Detail Display
| Row Name | Definition/Location |
| Patient, and Patient ID. | Patient > Profile |
| MRN | Patient > Treatment Episode > Intake > Patient Profile |
| Payer Name and Home Plan Payer. | Patient > Treatment Episode > Intake > Insurance > Insurance Set |
| Insurance ID and Group Number. | Patient > Treatment Episode > Intake > Insurance > Insurance Set > Policy Holder |
| Date of Service Start, Date of Service End, Service, and Units. | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Instances > Control Number > Details > Line Items |
| Claim State, Claim Status, and Claim Queue. | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Workflow |
| Claim ID, Claim Sequence, Claim Version, Submitted Date, and Total Claim Amount Charged. | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Instances |
| Payment DOS Start, Payment DOS End, and Line Item Amount charge. | Record Center > Insurance Payments > Payment Collections > Check Number > Details |
| Expected Amount, Covered Amount, and Amount Paid. | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim |
| Allowed Amount, Amount Paid to Facility, Amount Paid to Patient, Deductible, Coinsurance, Co-Pay, and Interest. | Record Center > Insurance Payments > Payment Collections > Check Number > Payment Collection > ICN > Details |
| Post Date, Deposit Date, and Check Number. | Record Center > Insurance Payments > Payment Collections > Check Number > Payment Collection |
| Is Latest | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Instances |
| Assigned User | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Workflow |
| Revenue Code and Procedure Code. | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Instances > Control Number > Details > Line Items |
| Bill Type and Place of Service. | Patient > Treatment Episode > Insurance Billing > Claims > Claim > Work Claim > Instances > Control Number > Details > UB-04 or CMS-1500 Contents |
| Payment Matching Status | Record Center > Insurance Payments > Payment Collections > Check Number > Payment Collection > Payments |
| Single Case Agreement | Patient > Treatment Episode > Scheduling and Utilization > Service Rates |
FAQ and Helpful Hints
Let's review some common facts and questions as well as helpful hints to improve our knowledge of this report!
FAQ
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The Allowed Amount is the maximum amount the plan will pay on the claim. This number is pulled directly from the payment as it displays in AveaOffice. This amount may have been received on an ERA or manually entered by a user when an EOB was received by mail.
This dollar amount is often calculated by the payer to include the Paid Amount + Deductible (PR 1) + Co-Insurance (PR 2) + Co-Pay (PR 3).The Covered Amount displays the total amount of billed charges covered by the insurance and is a report calculation that includes Paid Amount + Deductible (PR 1) + Co-Insurance (PR 2) + Co-Pay (PR 3) + Paid to Patient.
- The best report for determine the amount of payments collected in a time period would be the Claim Payments report. Billing companies often prefer the Summary version of this report to provide to their clients and will keep the report filtered on Matched Payments only. You'll want to be diligent in your close procedures and payment posting practices to ensure data accuracy since a user can update a payment posted in a prior period. Even if you use the summary version, we recommend you download and save a copy of the detail version; always run it at the same time as the summary so you have the details you need later for any comparisons
Helpful Hints
- Verifying Accuracy: To ensure accurate reporting, all posted payments and non-payments should reflect the service lines of the claim exactly. It is recommended the payer be contacted when a remittance does not match the claim exactly.
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Recent Data: Hover over time stamp below the Totals section to see the last time data was refreshed
- Line Items: Dates of service, Units, Charge amounts and Paid amounts are broken out to a separate line.
- Repeating Data: Claim ID, Check Number and other data will repeat on each line.
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