Insurance Payment Posting Overview

Insurance Payments (or non-payments) enter Avea electronically as an ERA (electronic remittance advice) or manually as entered by a user. 

Automatically Posted Payments

Check out the following articles to learn more about how payments are automatically posted in Avea and how to resolve any issues that occur during the automatic posting process. 

• Automatically Posted Payments (ERAs)
• Match Insurance Payments
• Review Insurance Payment Collections
• Resolve Insurance Claims Out of Balance

Manual Posted Payments (Add New Payment)

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. 

AveaOffice uses the Washington Publishing Company’s list of reason codes (ex: PR-3 is copayment, patient responsibility). A link to a list of the codes and their descriptions is below:

• Claim Adjustment Group Codes
• Claim Adjustment Reason Codes

Viewing Insurance Payments

Every payment in the system can be viewed under Records Center > Insurance Payments. From the Records Center, you can look at the bulk checks as a whole under Payment Collections, drill down by individual payments under Payments, or look at any whole check adjustments under the Provider-Level Adjustments tab.   

• Payment Collections: This is where bulk check information lives. Here you can filter by Organization, Start or End Dates, Date Type (Check, Deposit, or Post), and Check Amount. 
• Payments: This tab shows a breakdown of individual claim payments in the system. You can filter by the Organization, Practice, Start and End dates, Date Type (Post or Check), claim type (In Review, Matched, or Legacy, and Payer. 
• Provider-Level Adjustments: Similar to the other tabs, filter, and sort through payment information regarding whole check provider-level adjustments. These adjustments are categorized by the CMS PLB reason code guide. 

Payment Information

From any of the tabs under Insurance Payments, you can view additional details about the payment by clicking on the Check Number column.

1. This will take you to the Payment Collections > Details screen for this check.
2. From this screen, you can view:
   

   Source: Whether the payment came in paper, electronically, from a payer representative, or from a payer portal.  Payer Name: The payer that the check was issued by  Type: Check, ACH, Insurance Credit Card, or Nonpayment  Check Number: The number assigned by the payer  Post Date: The date that the payment was posted in the system  Check Date: The date the check was issued Deposit Date: The date that the check was deposited. This will have to be manually set.  Check Amount: The total amount of the payment received. Provider Adjustment Amount: This is the total amount of adjustments added from the Provider-Level Adjustments tab.

3. Next, the payment allocations are displayed in the table. This includes the totals for the Payment collection, Line-items, and Payments.
   
   

   	Collection Total	Line-Item Total	Payments Total
   Claim Payments (excluding interest)	Check Amount + Provider Adjustment Amount - Total Interest	Subtotal Paid Amount of Matched Payment Line Items + Legacy and Unmatched Paid Amount	Paid Amount Subtotal Excluding Interest
   Interest	Sum of Interest column from Payments tab > Payments Totals line.	Sum of Interest column from Payments tab > Line-Item Totals line.	n/a
   Provider Adjustment Amount	Manually entered by user when creating check or from ERA	Sum of all adjustments from Provider-Level Adjustments tab.	n/a
   Check Amount	Total Check Payment Amount Including Interest. Manually entered by user when creating check or from ERA	Subtotal Paid Amount of Matched Payment Line Items + Legacy and Unmatched Paid Amount minus the PLA Total + Total Interest	n/a

4. To view the specific payments listed on this check, open the Payments tab.
   
5. The payments table displays key information like ICN, Claim ID, Patient, and the Billed, Allowed, Adjusted, and Covered amounts. 
6. To view a further breakdown of the payment, click on the ICN link.
7. Here, you can edit the payment, view the EOB, and see the exact breakdown of how the claim is adjudicated.
8. Also, you can edit the claim workflow or change the state of the claim. Edit Claim Workflow allows users to set a claims queue and status, add existing or new issues, assign a user, and add a follow-up date.
9. If the claim has been paid appropriately and you aren't waiting on any additional insurance payments, click Close Claim Instance.

Provider-Level Adjustments 

A provider-level adjustment will need to be created when there is an adjustment made by the payer that affects the whole EOB, not just an individual payment. Click here to learn more.