When posting insurance payments via Auto Post or Manual Post, users have the option of omitting adjustments from calculating into the balance when posted to Patient Accounts, as well as omit adjustments from being included in claims for (secondary) billing.
When Auto Posting, check the ‘Show Details’ button to view adjustment information from the remittance. You’ll notice two check boxes in the line-item detail for the remittance
Hover your mouse over each box to read the accompanying tool tip. When posting with the first/left checkbox checked, the adjustment will be omitted from all future claims
When posting with the second/right checkbox checked, the adjustment will not calculate into the balance of the service. This is useful when the payer has misused or duplicated codes from previous payers
The same functionality can be accessed via Manual Post Payments
Hover your mouse over each box to read the accompanying tool tip. When posting with the first/left checkbox checked, the adjustment will be omitted from the 837 (electronic billing)
When posting with the second/right checkbox checked, the adjustment will not post to Patient Accounts or calculate into the insurance/patient balance
Adjustments can similarly be omitted from Patient Accounts and from claims after the remittance or EOB has been posted via Auto Post or Manual Post Payments.
Go to Patient Accounts and search for the patient
Locate the line item you wish to modify in Patient Accounts, then click the pencil icon
to edit
In the All Payments For Note tab, find the posting to modify, then click the pencil icon
to edit
Both Omit boxes will appear on the line item for each adjustment posted to the service
Hover your mouse over each box to read the accompanying tool tip. When posting with the first/left checkbox checked, the adjustment will be omitted from all future claims
When posting with the second/right checkbox checked, the adjustment will not calculate into the balance of the service code
A third checkbox at the very top of the Edit Insurance Payment window can omit payment from claims
When checked, all adjustments will be marked to be omitted from future claims
It is a good idea to remain cognizant of adjustments being omitted from electronic or paper claims when submitting to an insurance payer for adjudication so that valid adjustments are not being mistakenly excluded.