Handle Unapplied ERA Receipts

In certain situations, INSIGHT Billing may not be able to identify claims in an ERA file. For example, the claim number in an ERA file may be listed 3695, when the full claim number in INSIGHT is actually 30863695. A claim in an ERA file may list a patient’s name as Fred, but INSIGHT has the name recorded as Frederick. Or, the CPT codes listed by the payer in the ERA file may not exactly match the codes that were billed on the claim. In these cases, you must manually match the claims in the ERA file to claims in INSIGHT.

Claims that cannot be identified are shown in the Unapplied Receipts section of the EOB Processing tab, within the Payments F5 tab. This section is only present if the system is unable to identify claims in an ERA file. It shows a Reason the system could not match the claim to one in INSIGHT. To edit this field, simply type your entry. The system will automatically save what you have typed.

You must match unapplied receipts manually. Follow the processes outlined below to match unidentified claims, claims that cannot be matched to the correct payer index, and claims that cannot be matched to the correct charges in INSIGHT.

Tip: Click the Print ERA button to create a paper-based ERA. This might help you trouble-shoot unapplied receipts.

Matching Unidentified Claims and Assigning Payer Index

Follow the steps below when the system is unable to locate a claim, or identify the correct payer index for the payment.

  1. Double-click on the line of a claim in the Unapplied Receipts section, or select Assign Unapplied, to open the Claim Research dialog box.
  2. The search fields in the Claim Research dialog box show all the known information about the unassigned receipt. If the payer index for the unassigned receipt cannot be identified, Unknown is selected under Payer Index for This Payment.

  1. To find a claim in Insight that matches the unassigned receipt, use the information pre-populated in the search fields, or enter your own search criteria. INSIGHT looks for matching claims as follows:

    Claim #: Displays claims that match any part of the claim number

    Amount: Displays claims that match the billed amount.

    Payer: Displays claims that match the payer name.

    Patient Last, First: Displays claims that match the patient first and last name.

    Service Date Start, End: Displays any claims that have service dates between the start and end dates.

Clearing any field causes that field to be excluded from the search.

Tip: Since all search criteria fields are pre-populated with information from the unassigned receipt, you should clear at least one field (typically the Claim #) before you begin your search. This causes Insight to locate claims other than the one indicated by the unassigned receipt.

  1. Once you have entered search criteria, click the Search button. All claims matching the search criteria will populate.
  2. Look at the name of the payer in the Payer text box. Then look at the payer index selected under Payer Index for The Payment (for example, Secondary). Verify that the Payer text box identifies the same payer as the payer listed in the corresponding column in the grid. If the Payer text box identifies a payer listed in a different payer column (for example, Primary) than what is specified under Payer Index for the Payment, click the correct setting under Payer Index for The Payment . For example, if the Payer text box shows Regence BCBS and Secondary is selected under Payer Index for The Payment, make sure that Regence BCBS is listed in the Secondary column. If Regence BCBS is listed in the Primary column, change the Payer Index for The Payment selection to Secondary.
  3. Click on the line of the claim to match to the unassigned receipt and then click the Use Selected Claim button. The dialog box closes. All unassigned information will be updated on the selected claim.

Matching CPT Codes

Follow the steps below when INSIGHT cannot match one or more CPT codes in an ERA to the codes that were originally billed on the claim form.

  1. Double-click on the line of a claim in the Unapplied Receipts section, or select Assign Unapplied, to open the Claim Research dialog box.
  2. Use the search fields in the Claim Research dialog box to look up the claim in INSIGHT, following the same process shown above.
  3. When you have located the correct claim, select the line of the claim in the Claim Research window so that it is highlighted in blue. Then select View Charges.

  1. On the left side of the Claim Research screen, you will see a list of all CPT codes billed on the claim in INSIGHT. On the right side of the screen you will see a list of all CPT codes shown on the EOB. In the same way that INSIGHT assigns an internal identification number to each claim, each CPT code within the claim also is assigned a unique ID number. The ID number must be assigned to the corresponding CPT code in the ERA file. Drag and drop the ID numbers for the Charges on the Claim to the ID column of the matching ERA Service Lines.

  1. When you have finished matching all unidentified CPT Codes, click Use Selected Claim. The system should now be able to apply the payment to the correct CPT codes on file.
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