🎋How to Handle Remittances in Manual Review

How to Handle Duplicate Remittances

Walkthrough

🥈Situation 2: The unposted remittance is accurate

1. 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.



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2. The remittance for manual review will be in the Unposted Remittances list.
1. 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.
2. Looking at the Posted Payments list, it is clear that a duplicate remittance was already posted for this DoS.



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3. 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.

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1. Write a note explaining the negation, then click Confirm.



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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.

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2. 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.
1. You can always click the Undo arrow in the Actions column to cancel a previewed change.

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1. 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.
1. Changes to the balance will update in the Procedure Summary in blue text.
1. 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.



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2. Once everything looks as expected, click Confirm Posting.



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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 a Second Decision Without a Clawback

• The payer stage doesn’t make sense in context

• We see the same payer name across remittances from all payers

• Mismatched payer name and index
• For example, remittances from BCBS show up as Payer 1, even though they should display as Payer 2

• Two payers for a patient are the same insurance
• This can happen, for example, if we have a patient’s primary insurance listed as secondary, and then that insurance sends back a remittance as the primary payer.

How to Fix These Cases

1. From Claim Details
1. Open an encounter, then click the expansion arrow on a procedure to see its payment ledger. Finally, click the dropdown menu in the ‘Payer’ column to change the payer.



2. 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.

1. With the Posting Tool

You can change the payer and adjust CARCs with the Posting Tool (check out this guide to learn how to use the Posting Tool).

1. 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.



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2. Scroll to the right to find the ‘Denied’ column. Click the - to edit, and add all adjustments to this column.
3. If you need to change the payer, click the payer in the ‘Ins. Priority’ column on the preview and select the correct priority (Primary, Secondary, or Tertiary).
4. Click Confirm Posting.



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Done!

How to Fix Them

1. Make a Custom Adjustment

2. Negate Both Items

1. From the Posting Tool page, find the encounter of interest and click the arrow to see all of its procedures. Locate the procedure to be modified and click Post/Adjust.



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2. For both the bad clawback and the payment item to which it applied, click the three dots under the Action column and choose Negate.

3. You’ll now see previews of both negations in the Posted Payments list, highlighted red.
1. The Posting Tool automatically shows previews of all potential changes. These changes will not take effect until you click Confirm Posting.
2. Check the blue preview text in the Procedure Summary section to see how your negations will affect the financial information of the encounter.
3. You can always cancel a proposed change by clicking the Undo arrow under the Actions menu.

4. If everything looks as expected, click the Confirm Posting button in the bottom right corner of the page.



Done!

Case Study

1. The payer initially denied a claim due to a non-qualifying diagnosis.

2. The practice wrote off the charge.

3. The payer later paid a portion of the claim. The claim’s status was listed as ‘Non-workable,’ requiring a review of the payment history and balance adjustment.

1. Locate the Encounter in Question
There are many ways to do this in Insights. Click this toggle for a walkthrough of the most efficient method for this particular case study.

1. From the Posting Tool page, open the Patient filter and use it to find the patient.



ii. Find the encounter of interest and click the arrow icon to see procedure and charge details. Find the correct procedure and click Post/Adjust.

1. Review Payment History.
💡 Open a separate tab so that you can view the Posting Tool and the Claim Timeline simultaneously. Click this toggle to learn how to locate the Claim Timeline.

Copy the Encounter ID from the Posting Tool page you’re currently on.



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Press Cmd + K if you’re on a Mac, or Ctrl + K if you’re on a PC, and a universal search modal will appear. Paste the Encounter ID into the search bar. Select the option to see that encounter on the Claim Details page.



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Once viewing the correct claim, click into the Timelines tab, which will default to the Claim Timeline. Scroll down until you reach the date of interest.



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✅ Now you can compare the Posting Tool and the Encounter Timeline side by side.

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1. Confirm that the payer has indeed issued a partial payment, despite the initial denial.

1. Check Payment History for Payment Reversal
1. Look through the encounter’s claim timeline to verify that the payment was not rescinded, ensuring that the amount is still valid in the system.

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2. Negate the Incorrect Write-Off
1. Under the ‘Actions’ column in the Posting Tool tab, click the three dots corresponding to the incorrect write-off. Choose Negate.



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2. In the popup, fill in the reason for the negation. Click Confirm.



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3. You can now see a preview of your negation, highlighted red, in the Posted Payments list.
1. 💡The negation won’t take effect until you click Confirm Posting in the bottom right corner of the page. For this walkthrough, we’ll wait until after the next step to confirm posting.



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3. Adjust the Balance

The new remittance will be displayed in the Unposted Remittances list.

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All remittances in the Unposted Remittances list with PENDING Posting Status post automatically every six hours, if no errors or negative balances will appear as a result.

1. To post only your negation and wait for automatic remittance posting:
1. Double check the preview result
2. Make any changes if necessary
3. Click Confirm Posting

However, any remittances in the Unposted Remittances list with ’Manual Review Required’ status will need to be manually posted.

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✅

 For this walkthrough, since the unposted remittances are in ‘Manual Review Required’ status, we will need to combine the negation with manual posting.

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With the Posting Tool’s (automatic and required) preview function, the Procedure Summary at the top of the page will update to show your potential changes in blue text.

The screenshot below shows how the Adjustments and Balance would be affected if the negation is confirmed.



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✍️ How to Preview and Post the Remittance Manually

Click the green checkmark next to the unposted remittance. This will bump it up into the Posted Payments list in preview mode and highlight it in blue, underneath the negation you just made.



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In the Procedure Summary, you can now see how both the negation and the new remittance would affect the Adjustments and Balance, should they be confirmed.



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Ideally, the preview of the negation and the new remittance will create a new balance of $0, or otherwise yield the result you expect.

You can always click the Undo arrow next to any preview item to remove it from consideration.



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Once the preview matches your expectations, click Confirm Posting.



The changes you made can now be found in the Posted Payments list.

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If you need to make a custom adjustment and would like a walkthrough, see the end of the Posting/Adjustments Tool (with Preview Mode) section of this guide.

Done!

How to Resolve Negative Balances from Autoforwarded Claims