Claim and Payments by Insurance Set

This report provides users with a holistic view of all insurance sets, total charges, and insurance payments associated with a patient's treatment episode.

Generating the Report

Let's review how to create the Claim and Payments by Insurance Set report! 

1. Navigate to the Reporting section.
   
2. Under Billing Reports, select the Claim and Payments by Insurance Set Report.
   
3. Update the Date Type filter to create criteria for the system to identify which patients should be included in the report.
   
4. Enter the Start Date and End Date to create a date range.
   
5. Finally, click Create Report to complete the process.
   
    

Viewing the Report

This report will provide a line item for each insurance set a patient has. For example:

• If a single patient has two treatment episodes, and each has an insurance set, they would have two lines in the report

• If a single patient has two treatment episodes and each has two insurance sets, they would have four lines in the report

• If a single patient has one treatment episode with one insurance set, they would have one line in the report

Columns and Definitions

Row Name	Definition
First and Last Name	Displays the patient's name found in the Patient Profile tab.
Account Number	Displays the account number associated with the treatment episode.
Address/City/State/Zip	Displays the patient's home address.
Admission Date	This is the date of admission set within the Intake subtab of the patient's treatment episode.
Discharge Date	This is the date of discharge set within the Intake subtab of the patient's treatment episode.
Practice	Displays the practice associated with the treatment episode.
Primary Medical Payer	Displays the primary medical payer within the patient's insurance set.
Primary Behavioral Carve-Out	Displays the primary behavioral carve-out within the patient's insurance set.
Charges	This is the sum of all charges billed to insurance with the patient's insurance set.
Paid by Insurance	This represents the total amount of all payments made by the payer.
Deductible	Displays total deductibles left after the insurance has paid.
Co-Insurance	Displays the total co-insurance left after the insurance has paid.
Co-Pay	Displays the total Co-Pay left after the insurance has paid.
Patient Responsibility	Displays the total patient responsibility from PR-adjustment codes after the insurance has paid.