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Insurance company did not pay the full amount

Whenever we submit a claim to an insurance company there is the chance that they will not cover the total amount. By changing the approved column it will put the outstanding amount back onto the Clients account.

This is all handled when you post the payment for the Claim.

You can see there are a few columns on the "Post Payment" window.

  • Charge: Full amount charged to Client
  • Estimate: How much we think the payer will cover
  • Approved: How much the payer will cover
  • Total Paid: How much the payer gave us so far
  • Payment: How much the payer gave us this time

Example:

  1. Charge: $100
  2. We estimate we will get $80 from Blue Cross and submit the Claim
  3. Blue Cross only approves $60 so we adjust the approved column to $60 and apply the payment
  4. The extra $20 we were expecting from Blue Cross will be put onto the Client accounts as an outstanding bill
  5. You can now post a payment on the Clients account for the $20
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