Insurance Payments can end up in the Review Insurance Payment Collections tab when the payment was matched to a claim but some issue occurred when applying the payment to the claim.
Commonly encountered issues include:
- Check/Payment Total Mismatch
- Payments/Adjustments Not Posted
- Possible Duplicate
- NPI Not Matched to Organization
These Insurance Payments need to be reviewed and any discrepancies resolved before they can be considered complete.
Locating Payment Collections Requiring Review
Any insurance payment received that requires additional review will appear in the Insurance Payment Collections in Review tile in the Insurance Payments section of the Organization Dashboard (Management Center > Organization Dashboard).
Clicking on this tile takes you to the Work Center > Insurance Payments > Review Payment Collections.
We recommend reviewing this section daily and working it to zero, if possible.
Payment Collection Review Reasons
Review the following common issues and resolutions.
Check/Payment Total Mismatch
This review reason means that the sum of the payments does not match the amount of the payment collection (e.g., the Check Total doesn't match the applied Payments total).
- Click Edit to Resolve.
- Click on the Payments tab.
- Review the payments.
- Ensure all necessary payments are posted correctly. Click on the ICN to make updates to the payment, if needed.
Payments/Adjustments Not Posted
This review reason means that the payment collection was created but does not have any payments posted to it for claims.
- Because it's likely you'll need to manually post the payment details received, click View EOBs and download to have access to the payment information.
- Next, click Edit to Resolve.
- Navigate to the Payments tab.
- Select Create Payment to add payments under the collection.
- Alternatively, if the collection was added by mistake, click Edit to Resolve, and click Delete to remove the check.
This review reason means that the payment collection was flagged for possibly being a duplicate of another payment collection posted in AveaOffice. Review both payment collections to determine if one is a duplicate of the other and delete the duplicate.
- Click Resolve Duplicate.
- Evaluate the information and determine if the collection is a duplicate.
- Choose to Approve or Delete. Note: Deleted payment collections cannot be recovered.
- Then Resolve.
NPI Not Matched to the Organization
It's possible for the NPI on an EOB/ERA to not match the NPI for practices under the organization in AveaOffice. This could be because the NPI is not needed for billing, but the payer has it on file for other purposes. For payment collections with this review reason, view the EOBs to determine if this is for the organization and approve or delete the payment collection.
- Click View EOBs to determine if the patients and EOB are intended for this organization.
- Click Resolve to approve or Delete the payment collection. Note: Deleted payment collections cannot be recovered.