As a payment poster, your number one priority is to post payments in a timely manner so claims can be closed or sent back to the payer for reprocessing, while also diligently labeling claims in AveaOffice so billing collections can follow up on reimbursement issues with the payer. Payment posting is crucial and should be prioritized to avoid team members calling on claims for status and wasting time on the phone.
Payment posters are responsible for posting payments in a timely manner, closing claims that are paid according to the expected rate, and assigning claims back to the Billing Collections team for triage.
Billing collections will take over triage once the payment has been posted and sent back to the payer queue for follow-up.
Go to Work Center > Insurance Payments > Review Insurance Payments
Resolve all payments in this list.
Matching ERA payments first ensures that there is no double posting from the payments you will post manually.
Don’t worry about closing these claims or triaging them now. The claims will automatically be placed in the Payment Review queue for follow-up on the next business day.
Adding a payment note while in the Resolve screen will show on the claim page when “Payment Notes” is check-marked.
Post Payments Received
Go to Work Center > Insurance Payments > Enter Insurance Payment Collections.
Select the organization.
Click Create Payment Collection
Shortcut: Use Work Center Home > Upload Documents to upload an EOB file that creates the shell of the check for you. Create all the checks you’ll be posting, then go back in to post the payment details.
Posting these payments to claims will automatically put them in the Payment Review queue for your next step.
Review Payments Received
Go to Work Center > Insurance Claims > Work Claims
Filter to “Payment Review” Queue
Open each claim in a new tab
Review the payment note
Go to Payments
View the EOB
Click on the Check number to see how the payment applied.
It may be helpful to review previous notes to get an idea of the claim’s history before adjudication.
Use the Claim and Service Totals table at the top of the claim page to quickly see if there is a balance on the claim. If the Balance (Difference Covered vs Expected) is not zero, the reimbursement might not meet the expected rate.
Compare the reimbursement to similar claim reimbursements to ensure claims are paid similarly.
Update claim workflow in AveaOffice
Click Edit Claim Workflow within the payment.
Update the Queue
Update the Status
Add an Issue (optional)
Assign a user (optional)
Update the follow-up date
Set up your queues so it’s easy for payment posters to find where to send a claim i.e. “Closed” for closing claims or “Payer” for troubleshooting reimbursement issues.
Close the Claim (Situational)
Click Close Claim Instance
Only close the claim if the payment meets the expected rate. Otherwise, the claim should be sent back to the Payer queue for Billing Collections to troubleshoot the reimbursement with the payer.
You can also close claims from the Workflow tab or the patient’s Claims tab.
Repeat for each claim that has received payments in the Work Center.