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Applying Contractual Adjustment

GO TO

BILLING → VIEW CLAIMS → SEARCH CLAIM ID → POST PAYMENT

STEPS

  1. Enter the allowed amount in the allowable field as seen in the EOB
  2. A line item will then be populated showing this adjustment
  3. To Zero out the balance for amount owed by insurance, adjust the amount as contractual
  4. User Correction – to correct any mistake in posting. This can be used to add or deduct funds to adjust the balance
    1. Example: adding $50 adjusts the balance under Amount Owed

  5. Transfer Back – appears every time a balance is moved from one entity to another. This option is
    used to return a balance back to where it came from
  6. Secondary Transfers – to move a balance from the primary to the secondary insurance
    1. Example – $100 is patient’s copayment, since patient has a secondary insurance, this will then be transferred to that insurance and not the patient by choosing Secondary Transfers

  7. Claim History – shows the history of adjustments and details of the check entered into the system for the payment
  8. Selecting the Edit Payment link pulls up the Payment Editing Tool
  9. If you need to adjust a payment, simply indicate the value to add or deduct to the payment amount
    in the Adjustment Amount field

    1. Example: the payment for 99214 should only be $75, but it was incorrectly entered at $100. Enter the amount to deduct in the Adjustment field and hit Submit

NOTES

Types of Patient Transfers:
  • Balance Bill – used to bill the entire balance to the patient
  • Coinsurance
  • Copay
  • Deductible
  • Other (to bill a portion of the balance to the patient that doesn’t fall under balance bill,
    coinsurance, copay, or deductible
Types of Voids: (will void the entire line item)
  • Duplicate
  • Global
  • Void (deleted a claim created in error)