Insurance Payment Posting Overview

Payments in the RCM are recorded via electronic posting or manually by a user. Each check received triggers the creation of a Payment Collection representing the full amount. Once created, individual payments are issued and applied to their respective claims. 

Given the complexity of payment details, understanding when and where payment information is available is crucial to maintaining a healthy revenue cycle.

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.

Payment Collection Overview

Each collection represents a single check received as reimbursement for services rendered. Each collection has three tabs with additional information about the check. Let's review these sections together! 

• The Details tab of each collection shows the details entered for the check, such as the payment date, check number, and post date.
  

  ---

  This section also includes a table with three columns and three rows of totals. A successfully posted check will display no red, and the totals at the bottom of the table will equal the sum of each column's values.
  

  • Line Item Name	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 the Payments tab > Payments Totals line.	Sum of Interest column from the Payments tab > Line-Item Totals line.	n/a
    Provider Adjustment Amount	Manually entered by the user when creating a check or from ERA	Sum of all adjustments from the Provider-Level Adjustments tab.	n/a
    Check Amount	Total Check Payment Amount Including Interest. Manually entered by the user when creating a 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

  ---

  If any column values are red, it indicates an accounting error in the collection that needs to be resolved to ensure the check is accurately accounted for in the RCM.
  
  For example, the values in the Line-item Total and Payments Total columns will be displayed in red when the sum of all payments recorded within the collection does not match the check amount.
  
  Unresolved errors will trigger the system to flag the collection for review in the Organization Dashboard.

• The Payments tab of the collection displays the billing information for each claim for which a payment was created and applied. Additionally, this section provides quick links to information about the payment, claim, or patient.
  

  ---

  Clicking the ICN hyperlink for each claim opens the payment's Details section, which provides more information, including adjustment codes, services, and service modifiers (when present).
  

  ---

  In the Details section of the payment, clicking Edit Payment allows users to make adjustments as needed and ensure it is balanced.
  

• Similar to the Payments tab, the Provider Level Adjustments section details any provider-level adjustments made to the check before the payment was issued. To learn more about provider-level adjustments, click here.
  

Automatically Posted Payments

When a remit is received from a payer, the system will automatically post the payment to the claim once all data points from the payment and the claim have been matched. When one or more of those data points do not match, the system will flag the payment and require manual matching to ensure the correct payment is applied to the correct claim. To learn more about automatic payment posting and matching insurance payments, click here.

Manually Post Payments

Insurance payments received by mail or via insurance credit card will require manual posting. For information on posting manual payments, including those with provider-level adjustments, click here.

Resolve Out-of-Balance Collections and Claims

Ensuring the accuracy of all payment-related information is crucial to maintaining data integrity and recognizing revenue. The RCM provides users with multiple systems for finding and flagging out-of-balance claims and collections. To learn more about these systems and how to resolve related balance issues, click here.