At a Glance
This guide covers what posting is, how posting works in Insights, and includes links to guides for the tools at your disposal to make changes to posted payments.
What is Posting?
In Insights, posting is the act of adding a payment to an encounter’s payment ledger.
Most often this refers to posting insurance payments, but patient payments are also considered posted.
❓What is the Payment Ledger?
The payment ledger is a log that tracks every posted payment for its encounter.
It looks like this:
Payments posted into a ledger cannot be directly altered or deleted. They can only be modified through a future adjustment or negation. This ensures that all historical payment information remains visible and intact.
Insurance payouts can be complex and unintuitive, in terms of both the amounts paid and the time elapsed between submissions and decisions. Maintaining all historical payment information is extremely useful in figuring out who paid or adjusted what and when, so that claims can be finalized with confidence that the correct amounts were paid in full or written off.
Where to Find the Payment Ledger
From the Claim Details page, click into an encounter.
Then, in the Payment Overview tab, click the dropdown arrow next to a procedure to view the list of payments that make up the payment ledger for that procedure. Remittances, patient payments, and adjustments will all get logged here.
🔄 Refresher: The Life Cycle of a Claim in Insights
Here is a quick refresher on the basic life cycle of a claim.
- A provider has an encounter with a patient.
- An insurance claim is created representing that encounter.
- The claim is submitted to the patient’s primary insurance (’Payer 1’).
- Payer 1 decides whether to approve, partially deny, or deny the charges, and they send a remittance explaining the details of their decision.
- The remittance is posted in Insights.
- Specifically, it is posted to that encounter’s payment ledger, as shown below.
The encounter’s claim timeline also shows when it was posted in context of the claim’s overall progress.
In the example below, we can see that one of our clearinghouses, Change Healthcare (CHC), received remittance data from the patient’s primary insurance on the morning of October 17. The payment was then posted to Insights that afternoon.
- Any unpaid balance becomes the ‘Next Payer Balance.’
- If the patient has secondary and/or tertiary insurance, Athelas pushes that balance to the next payer and the process repeats (for ‘Payer 2’ or ‘Payer 3’).
- If any PR balance remains after all payers have made their decisions, the balance is either:
- Pushed to the patient as Patient Responsibility, or
- Written off.
- The claim is then finalized and closed.
Sometimes, the claim’s stage will be listed as ‘Finalization Pending.’ This occurs when remittances associated with the encounter require manual review. Posting those remits or archiving them will lead to finalization.
Here’s a visualization of the process described above.
🧧 How a Remittance is Posted
Claim Submission
When a claim is initially submitted, the total charge amount becomes the encounter's outstanding balance. This is the full amount that we expect to be allowed, or adjusted off by the payer.
After the payer adjudicates the claim, Athelas will receive raw remittance data from the payer (and sometimes from payer portals, faxbacks, or scanned EOBs). These remittances are matched back to their originating encounters and prepared for automated review.
Remittance Review
Newly received remittances begin in a pending state and are queued up for review by the Athelas Posting Engine, which runs several times a day.
The Posting Engine evaluates each remit and does one of the following:
Post
If this is the first remittance, or if it doesn’t conflict with currently posted remits, then the Posting Engine posts the remittance. Posted remits are permanently written into the encounter’s payment ledger. Details on the payment ledger are available at the beginning of this guide.
Archive
The Posting Engine archives remits if it recognizes that they’re duplicates. These remittances require no further action. Our operations team can unarchive them manually if necessary.
Flag for Manual Review
This occurs when the Posting Engine recognizes that a remittance conflicts with other remittances already posted.
For example, if a patient’s primary insurance sent a remittance for $100 last week, but today they sent a remittance for $120 for the same encounter (without providing a reversal of the previous decision), the second remittance would be marked for manual review.
Remits marked for manual review will be addressed by Athelas or your staff via the Posting Tool.
Generally, remittances are blocked because posting them would create a negative balance. Negative balances commonly occur when earlier decisions have yet to be negated, and can usually be solved through a combination of negations and/or manual adjustments.
You can also archive the remittance if that's the appropriate action.
🥊 Adjustment Rules Engine System (ARES)
Once remittances are posted, there are a number of automated adjustments that may be performed -- a key step in the process -- which are handled by our Adjustment Rules Engine System, or ARES.
ARES is our proprietary engine that runs once per day. After remittances are posted, it analyzes payments and applies established rules to adjust them.
📊 Here are some example rules:
- Write off PR if the patient’s primary insurance is Medicare.
- Push all procedures with CARC-XYX to PR.
In short, the rules in ARES’ library range from extremely broad to microscopically specific. Most of its rules are global, but custom rules can be configured to your practice’s specific needs. Your account manager can assist in this process.
Finalizing Encounters
Once all payer balances have been resolved, any potential PR balance that remains will be pushed to the patient and the encounter will enter Patient stage. When the patient pays the balance, or when it is written off, the encounter will then enter the Finalized stage.
If there are any pending remittances, the encounter will enter the Finalization Pending stage instead of the Finalized stage. Posting the remits or archiving them will lead to finalization.
Related Guides
Check out this guide to learn more about encounter stage and status.
This guide will walk you through posting and archiving remits.
❗Important Notes on Remaining Balances
Insights assigns a ‘Balanced’ or ‘Not Balanced’ designation at the encounter, payer, and procedure levels. Encounters are only considered balanced when the following equation is true:
Charges - Payments - Adjustments = 0
This approach enables tracking of small, unresolved amounts that payers may try to slip by you without paying.
Each encounter has a calculated Outstanding Balance. It won’t be considered to be in the ‘Finalized’ stage until every dollar has been accounted for. This makes it simpler to target partial denials and underpayments.
In Conclusion
We’ll briefly reiterate the key points in the lifecycle of a claim, as related to remittance posting.
First, all encounters start with their full charge amount as the outstanding balance. Most remittances are posted automatically, but some require manual review. For those cases, you can make good use of these posting tools.
Many situations leading to unpaid balances may be handled by ARES. Your account manager can help establish and update the rules that should be applied. This will enable you to make the greatest use of automation and minimize the amount of manual intervention required on tricky remittances.
Keep in mind that for PR to flow to the patient, payers’ outstanding balances will first need to be paid or written off. Once all balances (including PR) are resolved, the encounter will be finalized.
FAQs About the Posting Process
- Do denials affect an encounter's balance?
- Yes and no. Denial amounts can be thought of as a starting bucket for payer adjustments populate when Athelas flags them for review. Upon posting, certain adjustments will be considered ‘Denied’ and moved to the Denied column of the ledger.
- Denied adjustments do now lower an encounter's outstanding balance, which means an encounter that is fully denied will still have 100% of its balance. These amounts will need to either be pushed to PR, or written off depending on the CARC.
- Do posted payments and adjustments affect the balance?
- Yes. Posted payments and adjustments affect the balance, which we eventually want to reach zero.
- Adjustments – whether manual or automatic – will generally move amounts from the Denied column into Other PR or Other Adjustment columns.
- What if a balance will never be paid?
- These charges should be written off.
🔗 Related Guides
Check out these guides for specific information on Posting features in Insights.
📢 Further Assistance
Please contact your account manager if you’d like some hands-on assistance. We’re here to help!
Powered by