While many payments received in Avea are automatically matched and applied to the appropriate claim, there are some payments that you may need to manually post. You can manually post insurance payments received with paper EOBs by creating a payment collection, importing the related claims, and posting the payments and adjustments until all remits are posted and the payment collection is balanced.
Manual Payment Posting Video
Check out the following video for a quick overview of manual posting payments.
Add a Payment Collection
A Payment Collection is a grouping of remits; most often this refers to a check. However, this can be misleading as even nonpayments must be associated with a collection. It is common for payers to process multiple claims for various patients under a single check (e.g., payment collection). Any collection with more than one remit is a bulk check.
The first step to manually posting payments is to create the Payment Collection with the check details.
Tip: Before creating a new Payment Collection, search by check number in the header search bar. This will help prevent duplicate checks from being input into Avea.
- Navigate to Work Center > Insurance Payments > Enter Insurance Payment Collections.
- Select the Organization.
- Click, Create Payment Collection.
- Complete the following fields:
- Payer Name: Select from the list of payers within this organization.
- Source: Choose Paper, Payer Portal, Payer Representative, Client Date Import, or Manual.
- Type: Choose the payment type. Options include ACH, Check, Insurance Credit Card, Nonpayment, or Reversal.
- Check Number
- Check Date
- Deposit Date: optional
- Check Amount: $0 is a valid entry, as payers issue nonpayments under checks as well.
- Provider Adjustment Amount: Unless explicitly stated on the EOB, leave this value at $0.
EOB Files: Upload a scanned PDF copy of all the EOBs under the collection. This can be all in one or up to 5 different files. Ensure that all EOBs within the collection are accounted for.
Note: Only PDF file types are allowed.
- Click Create.
- This automatically opens the Payment Collection details page.
Add a Payment
Once a collection is created, record the insurance payments under the collection. Payment is an umbrella term and can refer to any remit regardless of whether there was a paid amount. We recommend posting each payment line item (rather than just the payment totals). This ensures the highest quality reimbursement data is recorded in AveaOffice for reconciling with billed treatment charges since it relates an exact paid amount, adjustment code(s), and corresponding dollar values directly with a revenue and/or procedure code by date of service.
- From the payment collection details page, click on the Payments tab.
- Click Create Payment.
- Next, select the following in order, as each selection narrows down the remaining options, e.g., once a practice and payer are chosen, the patient menu will only display patients associated with the selected practice and payer.
- Patient not listed? Override Payer to select patient: 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 and indicate the Payer (the insurance company listed on the EOB. Then, select the Override Payer (this is where the claim was submitted to initially).
- 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 for the payment you are posting.
- Enter an Internal Control Number. This is the payer’s claim number. It can usually be located on the EOB.
- Note: The Overrides EOB Adjustments toggle does not currently have functionality and can be ignored.
- Select Import. We recommend leaving the Import Services from Claim drop-down to One Row per Claim Line Item. This ensures you can post payment details for each individual service.
- This fills in the date of service, service, and billed information based on the claim information in AveaOffice and allows you to more easily post by line item. Generally, it is best to emulate precisely what is on the paper EOB.
- In the Payment Totals line, fill in the total allowed, deductible, coinsurance, adjustments, and paid amount for the entire claim. We'll calculate the Patient Responsibility later.
- For each line item row, fill in the allowed, deductible, coinsurance, adjustments, and paid amounts. If there is only one line on the claim, the line item will match the payment totals row. If there is more than one line item, the sum of the line item columns should equal the payment totals line.
- Allowed: Paid (by Payer) + Patient responsibility.
- Deductible: Amount paid by the patient before insurance will pay.
- Co-Ins: Amount paid by the patient for covered health care after the deductible has been met.
- Adjustments: Used to explain why the full charge amount wasn’t paid.
- Paid: Amount Paid by Payer
Adjustments account for noncovered amounts that do not fall under the deductible, coinsurance, or paid-to-provider amounts, e.g., PR-3 is copay for which the patient is responsible.
- Click Add Adjustment Line to enter an adjustment.
- Select the Adjustment Prefix and enter the Reason Code. Then, enter the adjustment Amount.
- Generally, this information should be copied directly from the EOB.
- Each line item can have more than one adjustment, click Add Adjustment Line to create another adjustment.
- Tip: Record Paid-to-Patient amounts as a PR-100 adjustment in the Adjustments column. Leave the Paid column as $0 to indicate no money paid directly to the facility.
- Enter any additional adjustment lines as needed by clicking Add Adjustment Line.
- Click Add Adjustment Line to enter an adjustment.
- Under the Adjustments column in the Payment Totals row, enter the sum of all the adjustment amounts.
- The total Patient Responsibility amount will be calculated automatically in the Line Item Totals at the bottom of the screen. You can verify this number by adding together that patient's Deductible + Co-Ins + Adjustments that are PR or OA-100 adjustments. Enter this in the Payment Totals row under Pat Resp.
- Fill in any remaining amounts, ensuring that the Line Item Totals and Payment Totals rows match.
- Click Create.
- Repeat the above steps to post all additional payments under the collection.
- When all payments are accounted for, the Payment Collection table won't display any red values. Values in red indicate something is out of balance.
Payment Out of Balance
If a payment is out of balance, check the following items:
Do the Payment Totals = Sum of all Line Items = Line-Item Totals?
- $10,000 = $2,500 x 4 = $10,000
Do the Billed Amount(s) - Adjustments (CO, most PI) = Paid + Patient Responsibility?
- If Billed $10,000 and Payer Adjusted $2,720 = Allowed $7,280
Do the Billed - Adjustments = Allowed = Paid + Patient Responsibility?
- If payer Allowed is $7,280 and there is no PR, paid should be $7,280.
- If payer Allowed is $7,280 and the patient has a $200 Deductible, Paid should be $7,080.
Recoups occur when money is being taken back by the payer (usually) due to overpayment and should never be posted unless the affected claim has been fully adjudicated (no other payments are expected).
Providers will be given a notice of a recoup and be given the option to either:
- Pay the money back directly (usually within 30 days of receipt), or
- Accept a reduction in benefits on a different claim, claim(s), and/or a check overall.
If necessary, recoupments can be posted through Provider Level Adjustments or Reversals (also called Negative Payments).
Provider Level Adjustments can add to or subtract money from a payment collection. Since these adjustments are not tied to any reports at this time, we recommend trying to always place the provider-level adjustment on the individual line-item itself (the individual claim payment) instead of the check as a whole.
- The only time we recommend adding a positive sum to a provider-level adjustment would be when the payer includes interest on the check as a penalty for paying provider late.
Reversals tell the system to keep a record of an incorrect payment but not actually apply it to the final balance of the claim. This allows the client to see the payment history of a claim without affecting the A/R.
- When a reversal has been applied to a payment, the system will automatically generate a negative collection/payment to offset the values from the incorrect EOB received.
- Reversals are appropriate for claims that have already been re-adjudicated or will be re-adjudicated.
- If you've received a recoup notice but have not yet received an updated version of the EOB, a reversal would be the appropriate solution until a final EOB/payment can be accurately posted.
The two-letter adjustment prefix, Remark Code, or Group Code assigns responsibility for the adjustment amount. AveaOffice uses the Washington Publishing Company’s list of reason codes.
|The provider is financially liable. Generally, considered a write-off for the provider and used when a contract is in place.
|Correction and Reversal
|No financial liability.
No financial liability, unless combined with code 100.
|Payer Initiated Reductions
|No financial liability. This is used by payers when the adjustment is not the responsibility of the patient, but there is no supporting contract between the provider and payer.
|The patient is financially liable. The adjustment amount should be billed to the patient. Deductible and Coinsurance are PR adjustments but must be recorded under their own columns, not the adjustment column.
Click here to check out the full Reason Code Inventory list from CMS.