Manually Post Payments

When paper checks and insurance credit cards are received as reimbursement for services rendered, payments will need to be posted manually. Let's review this process together!

User Permissions

Users with admin-level permissions can access and edit this information. For user-level profiles, additional permissions must be configured by an admin before access can be granted. For more information on user profiles and permissions, click here.

Manually Post Payments

Let's review how to manually post payments!

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 RCM.

Navigate to Work Center > Insurance Payments > Enter Insurance Payment Collections.
Click Create Payment Collection.
Update the Practice field when necessary.
Then select the issuing payer from the dropdown. If you do not see the payer in the list, click here for instructions on how to add them.
Update the Source drop-down to indicate how the payment was obtained to one of the following:
- Paper:
- Payer Portal:
- Payer Representative:
- Client Data Import:
- Manual:
Next, update the Type field to one of the following:
- ACH: Use this type when the payment was received electronically.
- Check: Select Check when a paper check is received.
- Insurance Credit Card (when configured): Select this type when you will be running a payment using an insurance credit card.
- Non-Payment: Use Non-Payment when posting $0 payments.
- Reversal: Use this type when posting recoups.
Then enter the Check Number.
Enter the Check Date listed in the upper-right corner of the check, and as a best practice, enter the Deposit Date.
The system will use today's date as the default Post Date, but this field is editable.

Note: The Period Close feature may interfere with backdating post dates.
Enter the Check Amount and the sum of all Provider-level Adjustments when applicable.
Then select Choose File to upload the EOBs sent with the payment.
When all documents have been uploaded, click Create and Add Payments to begin applying payments.
When successful, the system will confirm that the collection has been created and redirect you to the collection's Payments section. From there, click Create Payment.
In the payment window, confirm the Practice and Payer drop-down fields are correct.
Then locate and select the patient's name and the corresponding claim number in the Claim Instance dropdown.
Enter the Internal Control Number (ICN) as well as any pertinent notes when applicable.
Next, click Import Services From Claim to autofill the line items from the claim.
Enter the totals for each column as they are displayed on the EOB, except the Pat. Resp.* column. As a best practice, we recommend keeping the EOB open in a separate window for ease.
If all line items were paid equally, click Auto-Fill Payment Lines.
Confirm the allocations in the EOB for the individual payment, and enter the payment totals at the top of each column. Red values indicate the sum of the line items does not match the payment total listed at the top. For more information on resolving out-of-balance payments, click here.
Then enter the Line Item Total for Patient Responsibility in the Pat. Resp. field at the top of the column.
Once you have confirmed that the Payment Totals at the top match the totals at the bottom, click Save to complete the process.

Manage Posted Payments

Click below to learn more about managing posted payments.

Let's review how to manage payments that have already been posted to a claim!
1. From the Work Claim screen, click Payments.
2. Locate the correct payment, then click the check number.
3. Next, click Edit Payment.
4. Update the desired fields, then click Save to complete the process.
  
  Note: if a patient's billable was already created, you must reopen and close the claim again to ensure the balance is reflected.

Insurance Credit Cards

Some payers send a pre-paid credit card in lieu of a paper check when adjudicating claims. The RCM allows users to process those cards once merchant services are configured. Collecting a payment from an insurance credit card uses the same process outlined, with the exception of an additional step in between creating the collection and creating the payments.

Let's review how to collect a payment from an insurance credit card.
1. Follow steps 1-12 outlined in the manual payment posting process outlined above.
2. In the Payment Collection, click Collect Payment.
3. Enter the name on the card, then the card number.
4. Then enter the expiration date and your practice's zip code.
5. Next, enter the amount you wish to pull from the card. This will usually be the check amount.
6. And update the Practice drop-down when appropriate.
7. Add any pertinent notes, if applicable, and click Collect Payment.
8. Once the payment has been collected, resume the manual payment posting process at step 13 to complete the posting.

Provider-Level Adjustments

Occasionally, payers will reduce or increase the amount of a check due to overpayments, penalties, or interest. Since these adjustments are usually not tied to a specific patient or claim, a provider-level adjustment (PLA) needs to be created to ensure balanced payment collection.

Let's review how to create PLAs!
1. In the Payment Collection, click Provider-Level Adjustments.
2. Next, click Create Provider-Level Adjustment.
3. Update the Practice drop-down.
4. Then the Payer drop-down.
5. Enter the Adjustment Reference Date and add any pertinent notes when applicable.
6. Next, enter the two-letter reason code.
  
  Note:the system will pre-fill the Description field upon entry.
7. Then enter the Reference Number associated with the adjustment.
8. Enter the adjustment amount, then click Add Line to add multiple PLAs when applicable.
9. Finally, click Create to complete the process.

Helpful Hints

Click below to learn more about some commonly asked questions.

Adjustment codes are used to explain reductions in payments made directly to the facility. These codes include 3 parts: Code Type, Code Number, and Dollar Amount. There are five categories of adjustment codes used when adjudicating a claim offset. Let's review their definitions together.

Code Type	Definition and Number	Expected Behavior
CO	CO adjustments indicate that a payment was reduced due to in-network contracting.	CO adjustments are used to offset the balance of a claim after a payment is received for less than the claim's billed amount.
OA	OA adjustments mean Other Agreement, often seen when billing Single Case Agreements.	OA codes will not generate patient responsibility unless the accompanying number is 100 or greater. For example, an adjustment of $400 to OA104 would instruct the system to generate a patient bill for $400.
PI	PI adjustments are used by payers when the adjustment is not the patient's responsibility.	PI adjustments may leave an unresolved balance on the claim.
PR	PR adjustments represent what portion of the payment reductions are the responsibility of the patient.	Organizations with the Patient Billing module will see billables created using the sum of all PR-adjusments (including deductible + co-ins.) that can be used to bill the patient directly. Organizations without the module may see an unresolved balance on the claim.
CR	Credits and Reversals can be used to bill the patient directly. of the patient, but there is no supporting contract between the provider and payer.	CR adjustments may leave an unresolved balance on the claim.

It is more common to encounter unbalanced payments when they were posted manually. During the posting process, the system will highlight problematic areas in red to prevent additional follow-up issues.
- When posting an individual payment, the Payment Totals at the top should always match the line item totals at the bottom. When these columns do not match, the line item totals for each column will be highlighted in red to help identify the discrepancy.
- There are two areas within the Payment Collection itself where unbalanced payments can be identified. As with individual payments, the totals at the top should always match the check amount at the bottom. When these values do not match, the system will highlight the areas in red.
  
  The Payments section of the collection lists the individual payments created and applied to claims. Incorrectly posted payments can be easily identified and resolved by locating the red text and clicking the ICN to open and edit the payment.
  
  If you are struggling to identify how the payment is unbalanced, ask the following questions:
  - Do Payment Totals = Sum of all Line Items = Line-Item Totals?
  - Do the Billed Amount(s) - Adjustments (CO + PI) = Paid + Patient Responsibility?
    ($4,000 - $300) = $3,700 = ($3,200 + $500) = $3,700
  - Do the Billed - Adjustments = Allowed = Paid + Patient Responsibility?
    ($4,000 - $300) = $3,700 = $3,700 = ($3,200 + $500) = $3,700
The RCM calculates a patient's responsibility using the following formula: Deductible + Co. Ins. + Co-Pay + Adjustments (PR codes and OA100+) = Patient Responsibility.
If payments were paid directly to the patient, we recommend entering $0 for the paid amount and adding adjustment code(s) PR-100 to account for the direct payment.
It is not uncommon to receive a payment for a claim from a payer different from the one to whom the claim was submitted. For example, when claims are submitted to BCBS OH/KY/IN, the payment will be issued from Anthem.

When this occurs, follow the same payment posting process as outlined in steps 1-14 above, then click the payer override button. This will generate another payer list; the payer on the claim must be selected to generate the correct patient list. Resume the process starting at step 15.