If an insurance company is not going to pay for the full amount that was claimed to them, there are two ways to record this in InnoCare Software, depending on what is happening to the remaining balance.
a. Balance Stays with the Payer
If an insurance company only pays a partial amount but you expect to receive the remaining balance from the payer at a later date, do the following:
- Change the amount in the Payment column to what the insurance company has paid. You can do this by following the steps outlined below:
- Go to Payers > Open Payer's Accounts and pull up the claim that needs to have the payment posted against it:
- Right-click on the claim and select Post Claim Payment Of...
- Change the payment amount to what the Insurer paid
- This indicates that the company has paid a certain amount, but we still expect more because the Approved column is set to the full amount
- This will auto-adjust the Amount section to what is being paid
- Click OK
- Click Yes to the Partial Payment warning
In Open Payer Accounts, the Status column of that Claim will update to Partially Paid
b. Balance Transfers to Client
If an insurance company only pays a partial amount, and you do not expect to receive balance from that insurance company, the balance must be transferred back to the client account for collection. This is done as follows:
- Change the Approved column to what the insurance company has paid. You can do this by following the steps listed below:
- Go to Payers > Open Payer Accounts and pull up the claim that needs the payment posted against it:
- Right click on the claim and select Post Claim Payment Of...
- Change the approved amount to what the insurer has offered to pay
- Because the Approved column has been changed to a lower amount, we no longer expect to receive the balance from the insurance company and it will transfer back to the client
- This will auto-adjust the Payment column and the Amount section to what is being paid
- Click OK
In Open Payer Accounts:
- The S column of that Claim will update to Complete
- An additional Payment line with a Complete status will appear
A new Transfer line for the amount of the Approve Payment will appear with the original Ref# in brackets and owing balance will now show in the patient's billing tab.