Billing Ledger - Claims (Primary or Secondary)

Note: A claim is automatically created for each appointment (when the patient has insurance) and secondary claims are automatically created once the primary insurance claim EOB is processed if the patient has secondary insurance. If a secondary claim is created, it will appear on the ledger but the patient responsibility will not be updated (same as the previous ledger design).

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From the patient billing, click the drop-down next to the appointment to open it.

 

Click the drop-down next to Claim (Primary or Secondary).

Note: The Claim Entry will show you the status of the claim: Draft, Sent, Processing EOB, Denied, Paid, Overpaid, Underpaid.

 

You can view the claim by clicking on the 3 Dot menu and then clicking View Claim.

 

When you open the Claim Entry you will see any payments associated with that claim.

Note: If no payments have been received it will show "No Payments".

This entry will show:

• Date of Payment

• Payment Type (EFT, Check, Virtual CC)

• Payment Amount

 

Next is the list of procedures associated with that claim.

 

To the right of the procedure, you will see 2 columns:

• Ins Est: This is the original estimated total for the insurance.

• Ins Pay: This is what the insurance actually paid.

Note: If the claim status is Draft or Sent, this will only show the Ins Est column.

 

In the event that insurance overpays or underpays, you will see an orange number under the Ins Pay column.

• If the Claim is Underpaid: You will see a negative number.
• If the Claim is Overpaid: You will see a positive number.

Note: This will create an Updated Patient Responsibility Entry.