At a Glance
This guide is intended to simply show you how to accomplish basic posting tasks in Insights as quickly as possible.
There are several other guides relating to Posting in Insights linked at the bottom of this page.
❓FAQs and Solution Walkthroughs
📬 How to Post a Remittance Manually
Insights posts remittances automatically every six hours, provided that doing so will not result in an error, negative balance, or other problem. You can learn more about remittances in manual review, some of problems that cause them and their solutions, with this guide.
If you would still like to manually post a remittance anyway…
📮 Here’s How to Do It
Navigate to the Posting Tool and filter for the encounter in question.
Click the arrow next to the encounter to see all its procedures. Find the one you’d like to edit and click Post/Adjust.
In the Unposted Remittances list, find the remittance you’d like to post. Click the green checkmark icon to ‘Add to Preview.’
This will bump it up into the Posted Payments list.
It will be highlighted blue, indicating that it is in (automatic and mandatory) Preview Mode.
The Posting Tool’s Preview Mode allows you to see the effect that taking a given action will have on the encounter’s financials — in this case, posting an unposted remittance.
You can see the changes that will occur, written in blue text, in the Procedure Summary at the top.
If anything looks incorrect, you can always click the ‘Undo’ arrow in the preview’s ‘Actions’ column.
Once everything looks the way you expect, click Confirm Posting.
Note that you can edit any of the categories of the remittance in preview mode by clicking them. Generally, editing them is not recommended. See this guide for more details on using posting tools.
💸 How to Push to PR
There are a few different ways to push charges to PR in Insights.
This walkthrough illustrates an efficient method using the Posting Tool page.
Important Notes:
- PR can take 10-15 minutes to generate. Please wait for our system to update before attempting to make further adjustments.
- We advise against creating negative balances when posting remittances or adjustments. Negative balances occur when total recorded payments exceed total charges.
⚡ Click here for a quick explanation of when PR gets sent to the patient.
- PR (whether sent to the patient's account or not) is a part of the Balance.
- PR is only sent to the patient when all other balances are resolved, such that
PR amount=Balance amount.
- So a balance consisting of $10 Denied + $20 PR will not go to the patient, because the $10 Denied must first be reconciled.
- When that $10 is resolved (written off, or added to the PR amount) we get one of the following cases:
- $0 Denied ($10 written off) + $20 PR, or
- $10 PR (moved from denied to PR) + $20 PR (previously existing)
- In either case, the balance will now be equal the total PR. This will cause it to be sent to the patient.
Navigate to the Posting Tool and filter for the encounter in question.
Click the arrow next to the encounter to see all its procedures. Find the one you’d like to edit and click Post/Adjust.
In the Posted Payments list, find the row with the payer charge to be written off. Click the three dot menu in its ‘Actions’ column and select Push to PR.
Fill in the amount you’d like to push to PR and write a note explaining the reason for the push.
Then click Push to PR.
You’ll see your pushed charge as a (mandatory and automatic) preview, highlighted green, in the Posted Payments list.
Check the potential result in the Procedure Summary section at the top, which shows potential changes in blue text. If something looks incorrect, you can always undo the write off by clicking the ‘Undo’ arrow in the ‘Actions’ column on the preview.
When everything looks correct, click Confirm Posting.
Done!
📝 How to Write Off a Balance
There are a few different ways to write off charges in Insights.
These walkthroughs illustrate efficient methods using the Posting Tool page.
Important Notes:
- PR can take 10-15 minutes to generate. Please wait for our system to update before attempting to make further adjustments.
- We advise against creating negative balances when posting remittances or adjustments. Negative balances occur when total recorded payments exceed total charges.
⚡ Click here for a quick explanation of when PR gets sent to the patient.
- PR (whether sent to the patient's account or not) is a part of the Balance.
- PR is only sent to the patient when all other balances are resolved, such that
PR amount=Balance amount.
- So a balance consisting of $10 Denied + $20 PR will not go to the patient, because the $10 Denied must first be reconciled.
- When that $10 is resolved (written off, or added to the PR amount) we get one of the following cases:
- $0 Denied ($10 written off) + $20 PR, or
- $10 PR (moved from denied to PR) + $20 PR (previously existing)
- In either case, the balance will now be equal the total PR. This will cause it to be sent to the patient.
😷 How to Write Off PR
Copay, coinsurance, deductible, self pay, and some miscellaneous charges all constitute PR. For all other charges, see the next walkthrough on how to write off a payer balance.
In the Posting Tool, find the encounter with the PR charge you’d like to write off. Use the filters to narrow your search if necessary.
Click the arrow next to the encounter to see its procedures. Find the procedure in question and click Post/Adjust.
In the Posted Payments list, find the row with the PR to be written off. Click the three dots in the ‘Actions’ column to open that menu, then select Write Off PR.
In this example, we’ll write off part of the deductible charge.
Fill in the amount you’d like to write off and add a note explaining the write off.
Click Write Off PR.
You’ll see your write off as a (mandatory and automatic) preview, highlighted yellow, in the Posted Payments list.
Check the potential result in the Procedure Summary section at the top, which shows potential changes in blue text. If something looks incorrect, you can always undo the write off by clicking the ‘Undo’ arrow in the ‘Actions’ column on the preview.
When everything looks correct, click Confirm Posting.
Done!
🏢 How to Write Off a Payer Balance
Navigate to the Posting Tool and filter for the encounter in question.
Click the arrow next to the encounter to see all its procedures. Find the one you’d like to edit and click Post/Adjust.
In the Posted Payments list, find the row with the payer charge to be written off. Click the three dot menu in its ‘Actions’ column and select Write Off.
Enter the amount to write off and a note explaining the write off.
Then, click Write Off.
You’ll see your write off as a (mandatory and automatic) preview, highlighted yellow, in the Posted Payments list.
Check the potential result in the Procedure Summary section at the top, which shows potential changes in blue text. If something looks incorrect, you can always undo the write off by clicking the ‘Undo’ arrow in the ‘Actions’ column on the preview.
When everything looks correct, click Confirm Posting.
Done!
📊 How to Change the Payer Status (Admin Only)
Changes to payer status can only be performed by Athelas staff.
If a claim is displaying the wrong payer, you can investigate and update the payer status in one of two ways:
- From Claim Details
- Open an encounter, then click the expansion arrow on a procedure to see its payment ledger. Then, click the dropdown menu in the ‘Payer’ column to change the payer.
- Refresh the page, double check that everything looks correct now, and make further changes as needed. If necessary, use the Posting Tool method described below instead.
- With the Posting Tool
- Open the claim in question and click the green checkmark on the unposted remittance to preview it. It will bump up to the Posted Payments section, highlighted blue to indicate that it is a preview.
- Click the payer listed in the ‘Ins. Priority’ column on the preview to open the dropdown menu, then select the correct priority (Primary, Secondary, or Tertiary).
- Click
Confirm Posting.
You can change the payer and adjust CARCs with the Posting Tool (check out this guide to learn more about the Posting Tool).
Done!
👯♀️ How to Handle Duplicate (or Nearly Duplicate) Remittances
🥇Situation 1: The currently-posted remittance is accurate (or they’re exact duplicates)
- Visit the Posting Tool page and find the encounter of interest. Click its arrow icon to see procedures listed by DoS.
- Find the procedure remit you want to review, then click
Post/Adjust.
- The remittance for manual review will be in the Unposted Remittances list.
- If you hover your cursor over the information icon, a tooltip will explain why this remit is unposted. In this example, we can see that the remit will create a negative balance (indicative of overpayment) if it is posted.
- Looking at the Posted Payments list, it is clear that a duplicate remittance was already posted for this DoS.
- In this case, it is safe to archive the unposted remittance by clicking the orange box icon in the Actions column.
🥈Situation 2: The unposted remittance is accurate
- Visit the Posting Tool page and find the encounter of interest. Click its arrow icon to see procedures listed by DoS.
- Find the procedure remit you want to review, then click
Post/Adjust.
- The remittance for manual review will be in the Unposted Remittances list.
- If you hover your cursor over the information icon, a tooltip will explain why this remit is unposted. In this example, we can see that the remit will create a negative balance (indicative of overpayment) if it is posted.
- Looking at the Posted Payments list, it is clear that a remittance was already posted for this DoS.
- Now, rather than archiving the unposted remittance as shown in the previous situation, we’ll negate the first and post the second.
Click the three dots corresponding to the first remittance under the Actions column. Choose
Negate.
- Write a note explaining the negation, then click
Confirm.
The Posting Tool page automatically shows you previews of the effects of all changes — negations, posts, edits — that you wish to make. No changes will take effect until you click Confirm Posting in the bottom right corner of the page.
- Your negation will be in the Posted Payments list, highlighted red, indicating that it is currently an unconfirmed preview. You can see how confirming this negation will affect the encounter’s financial information, written in blue text in the Procedure Summary.
- You can always click the Undo arrow in the Actions column to cancel a previewed change.
- We’ll preview both the negation AND the new posting together for this walkthrough. Click the green checkmark ✅ next to the unposted remittance. This will bump it up into the Posted Payments list in preview mode, highlighted blue, underneath the negation preview you just made.
- Changes to the balance will update in the Procedure Summary in blue text.
- In this case, as they are duplicate remittances, negating one and posting the other yields no change, but we’ll do it anyway to show the process.
- Once everything looks as expected, click
Confirm Posting.
If you need to make further adjustments to balance the encounter, this guide has information on making a custom adjustment. It can be found near the bottom of the Posting/Adjustments Tool section.
Done! Time for coffee. ☕
🎣 How to Handle Partial Denials and Unresolved Balances
First, here are some useful definitions of terms.
- Allowed Amount
Allowed Amount=Insurance Paid+Copay+Deductible+Coinsurance
- Denial
- Claim has $0 allowed amount as a whole
- Partial Denial
- At least one procedure has an allowed amount greater than $0, AND
- One or more of the procedures is denied entirely
- Unresolved Balance
- Every procedure has an allowed amount greater than $0, BUT
- Despite those allowed amounts, some portion of the charged amount has been denied on at least one procedure
- Example: An encounter has a procedure with $50 paid, $25 contractual adjustment, and $5 denied CARC
🐟 Walkthrough: Partial Denials
When dealing with partial denials, you have two options:
- Modify and resubmit the claim
- Adjust or write off the remainder
Let’s look at an example case.
To find partial denials, filter the encounters on your Claim Details page by ‘Encounter Stage Reason,’ then select ‘Partial Denials.’
Upon clicking into one of the partially denied encounters, we can see which procedure was denied based on a few clues:
- It has an outstanding balance, written in red
- Its ‘PR Status’ is listed as ‘Provisional’ (hover your cursor over this status to see a tooltip explanation)
- The encounter’s overall ‘Status’ is listed as ‘Not Balanced’
Click the arrow next to the procedure to see further details.
In this case, the red highlighted explanation indicates that the procedure code is inconsistent with the modifier used. If we were to resubmit the claim, the modifier would need to be modified.
See these guides for further instruction on resubmission:
Or, to go in the other direction:
🐡 Walkthrough: Unresolved Balances
Unresolved balances appear on encounters when payers send partial or unclear remittances. These cases require action on your part.
When dealing with unresolved balances, you have two options:
- Modify and resubmit the claim
- Adjust or write off the remainder
To find unresolved balances, filter the encounters on your Claim Details page by ‘Encounter Stage Reason,’ then select ‘Unresolved Balances.’
Upon clicking into one of the encounters with an unresolved balance, we can locate the procedures responsible based on a few clues:
- They have an outstanding balance, written in red
- Their ‘PR Status’ is listed as ‘Provisional’ (hover your cursor over this status to see a tooltip explanation)
- The encounter’s overall ‘Status’ is listed as ‘Not Balanced’
Click the arrow next to a procedure to see further details.
In this example, we can see the PI-59 adjustment of $6.84 was made based on multiple or concurrent procedure rules (like surgery or diagnostic imaging with concurrent anesthesia).
Now, you get to decide whether to modify and resubmit this claim or write it off!
If you find yourself performing the same action repeatedly to resolve many encounters, it could be worth consulting with your account manager about setting up a rule to handle those cases.
This may involve setting up Target Allowed Amounts [sic], so that the engine can close encounters with procedures that have been paid at or above a certain threshold of your choosing.
See these guides for further instruction on resubmission:
Or, to go in the other direction:
📚 Other Guides Related to Posting
Further Assistance
📢 We’re here to help! Please contact your account manager if you would like some hands-on assistance.
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