Processing Remittances

The Remittance Details window provides remittance information such as carrier, total payment amount, remittance status, payment type, and the number of claims associated with a remittance.

A status bar shows your progress as you post payments for a remittance. The bar gives you a visual indication of the payment amount applied to a remittance and the remaining amount that must be applied.

1. Search for a remittance with the Ready to Review or In Review status. See Searching for Remittances.
2. In the Remittance # column, click the link for the remittance.

   The Remittance Details window opens with the Not Applied tab displayed. The Not Applied tab includes all claims in the remittance that must be processed.

   If a warning message appears indicating the remittance may be a duplicate, you can delete the remittance. See To delete remittances identified as duplicates.

   In the Remittance Details window, you can perform the following actions:

   1. Select the Applied tab to see claims with payments applied for the remittance.
      • AcuityLogic automatically applies payments for claims with matching total receivable and payment amounts and places those claims in the Applied tab.
      • An indicator appears in the Payment Amount column for claims automatically placed in the Applied tab with nonmatching receivable and payment amounts. To remove the indicator, open the Claim Adjustments window, make any necessary changes, and save the payment.
   2. Select the Remittance Adjustments tab to see adjustments made for the remittance. See To add remittance adjustments.
   3. Review the status bar to see the progress of your remittance processing.
   4. Click Filter and use the following check boxes to filter claims in the remittance:
      • Claims to which payment rules were applied – select to show claims with insurance payment rules applied. For information on insurance payment rules, see Setting Up Insurance Payment Rules.
      • Claims with multiple payments – select to show claims with multiple payments. See To post multiple remittance payments to a claim.
      • Claims with non-matching line item payments and receivables – select to show claims with line items where the receivable and payment amounts do not match.
      The Filter drop-down list is available only if the remittance includes claims that meet one or more of the filter criteria. When you click Filter, only applicable check boxes appear.
   5. Use the Search field to search for claims in the remittance. You can search based on information in any of the columns in the claims table.

In the Remittance Details window, you can update the carrier, deposit date, or payment type for remittances with the following statuses:

• Ready to Review
• In Review
• Posting (with errors)
• Posted

When you update remittance details, you must select a carrier and payment type.

If the remittance is in Posting or Posted status, the deposit date is required. The date cannot precede or be within a month that is closed.

1. Open the Remittance Details window for a remittance. See To navigate the Remittance Details window.
2. Click Edit Details.
3. In the Edit Payment window, update the remittance details, and click Save.
   If you enter a future deposit date, a warning appears.

The Claim Adjustments window provides information for each claim in a remittance. You can review the remittance record that shows details for each line item in a claim and post payments for the line items. For information about posting payments, see To post remittance payments.

1. Open the Remittance Details window for a remittance. See To navigate the Remittance Details window.
2. In the Claim Number column, click the link for a claim to open the Claim Adjustments window.

   In the Claim Adjustments window, you can perform the following actions:

   1. To view the remittance record in a separate window, click the Open New Window icon. You can move the popup window to a second monitor.
   2. To review claim information in the remittance, expand the Claim Information section.
   3. To expand or collapse the remittance record section in the Claim Adjustments window, click the Expand/Collapse icon.
   4. Hover over a line item in the claim adjustments area (D1) to highlight the associated line item in the remittance record (D2).
   5. Click a line item's payment amount link to highlight the corresponding Payment Amount field in the claim adjustments area.
   6. To review explanations for claim adjustment reason and remark codes, hover over the codes in the Claim Adjustment Reason Code and Remittance Advice Remark Code columns.
   • The method you select for viewing the remittance record is saved as your default option.
   • For VSP remittances, you can review the grouped lens and lens option code line items in the remittance record. The total shown in the Payment Amount column for the lens includes the payment on all grouped lens items.

You can post payments to claims for remittances with the following statuses:

• Ready to Review
• In Review

1. Open the Remittance Details window for a remittance. See To navigate the Remittance Details window.
2. In the Claim Number column, click the link for a claim.

   The Claim Adjustment window opens.

3. If an error message indicates the status of one or more line items must be updated, follow these instructions:



1. In the message, click Update.
2. In the Update Status window, select the check box of the line items whose status you want to update.
3. Click Save.

   AcuityLogic changes the status of the line items to Billed in the Claim Adjustments window. If you do not save your changes in the Claim Adjustments window after you post payments, the status changes are reverted.

4. In the Payment Amount field next to a line item, enter the amount paid toward the item.

   To have AcuityLogic make an automatic adjustment so that the claim payment amount equals the sum of the payable line item payments, click the Automatically adjust line item icon.

5. From the Adjustment Type drop-down list , select an adjustment type for the line item.

   If you select one of the following adjustment types, you cannot enter additional adjustments:

   • Biller Review
   • Bill to Patient
   • Write Off

The following table describes the adjustment types.

Adjustment Type	Description
Adjustment	Performs an adjustment to the line item similar to adjustments made in the Claim Detail window. Enables you to change the outstanding receivable. Depending on the final outstanding receivable amount, the adjustment changes the line item status to Underpaid, Fully Paid, or Overpaid. If your company uses the General Ledger, a combination of the adjustment, reason code, and debit/credit can be mapped to a GL entry.
Bill to Insurance	Transfers the receivable amount entered to a secondary insurance carrier, and creates a claim. The receivable of the original line item is adjusted by the transfer amount and entered as the receivable for the line item on the new claim.
Bill to Patient	Transfers the amount in the Remaining column from the carrier to the patient. Performs the same action as clicking the Ready to Bill Patient button in the Claim Detail window.
Biller Review	Adds a marker to indicate that another biller must review the claim after the payment is applied.
Rejections	Changes the line item status to Rejected if the payment amount is $0.
Write Off	Performs a write-off to the line item similar to write-offs in the Claim Detail window. Enables you to change the outstanding receivable. Changes the line item's status to Written Off. If your company uses the General Ledger, a combination of the write-off, reason code, and debit/credit can be mapped to a GL entry.

6. In the Amount field, enter the adjustment amount.
7. Enter a comment or patient note in the appropriate fields if needed.
8. To record additional adjustments, click + Add More, and repeat the preceding steps for each adjustment.
   You can make three adjustments for each line item.
9. Do one of the following:
   • To return to the Remittance Details window, click Save.
   • To navigate to the next claim in the Not Applied tab, click Save & Continue.

   AcuityLogic posts the payment and moves the claim to the Applied tab in the Remittance Details window.

You can post multiple payments to a single claim in a remittance.

1. Open the Remittance Details window for a remittance. See To navigate the Remittance Details window.
2. To hide all the remaining claims for the remittance, click Filter and select the Claims with multiple payments check box.
   This check box is available only for remittances that include multiple payments for the same claim. It enables you to process those payments first.
3. In the Claim Number column, click the Multiple Payments icon () next to a claim.

   A review window opens with remittance details for the payments.

4. To review the remittance details for each payment, click the Plus icon in the Remit Details column.
   The payments in the review window are listed in the order that they should be processed based on the claim payment status.
5. Next to the payment you want to apply, click Review.

   The Claim Adjustments window opens for the payment.

6. Apply the payment, and make any necessary claim adjustments.
7. To navigate to the next payment, click Save & Continue.
   When you apply multiple payments for the same claim, clicking Save & Continue takes you to the next payment listed in the review screen.
8. Repeat the process to apply the remaining payments.

   The Remittance Details window opens after you apply all payments for the claim.

9. To show the remaining claims that must be processed for the remittance, deselect the Only show claims with multiple payments check box.

You can add remittance adjustments if the sum of the claim payments does not match the total payment amount for a remittance. For example, a remittance from VSP may include a Unity Savings bonus. Before you can post this remittance, you must create a remittance adjustment for the amount of the bonus.

1. Open the Remittance Details window for a remittance. See To navigate the Remittance Details window.
2. Click + Remittance Adjustment.

   The Remittance Adjustment window opens.

   

3. Enter the information for the remittance adjustment, and click Save.

   The adjustment is added to the Remittance Adjustment tab.

   • To update remittance adjustment information, click Edit.
   • To delete the remittance adjustment, click Delete.

If you recently moved to AcuityLogic Billing from another billing system, you can post remittance payments to external claims.

1. Open the Remittance Details window for a remittance. See To navigate the Remittance Details window.
2. Open the Post External Claim window by using one of the following methods:
   • For a claim marked with (E), click the link in the Claim Number column.
     When a claim in a remittance cannot be matched to a claim in AcuityLogic Billing, an (E) appears next to the claim number to indicate that it is an external claim.

     

   • Click the Find Claim icon () next to a claim in the Claim Number column, and then click Post External at the bottom of the Find Claim window that opens.
     Use this method when you want the payment posted to an external claim even though AcuityLogic matched the claim number to one found in AcuityLogic Billing.
3. Update the information in the Post External Claim window as necessary.



4. Click Save.

AcuityLogic posts the payment and moves the claim to the Applied tab.

You can update the claim associated with a remittance payment if you need to apply the payment to a different claim.

1. Open the Remittance Details window for a remittance. See To navigate the Remittance Details window.
2. Click the Find Claim icon () next to a claim in the Claim Number column.

   The Find Claim window opens.

3. Enter information for the claim that you want to find, and click Search.
4. Click the link for the claim you want to match to the payment in the search results.
5. In the confirmation message, click Yes.

   AcuityLogic updates the claim associated with the payment.

In the Claim Adjustments window, an indicator appears if the claim information in Billing does not match the claim information from the remittance. You can review the nonmatching information. If necessary, you can apply the payment to a different claim.

1. Open the Remittance Details window for a remittance. See To navigate the Remittance Details window.
2. Click the link for a claim in the Claim Number column.
3. In the Claim Adjustments window, click the indicator that appears next to the nonmatching claim information.



A window opens that shows the nonmatching information.

4. To apply the payment to a different claim, click Find Claim, and select the new claim in the Find Claim window. See To update claims for payments.

You can remove the payment posted to a claim for a remittance in one of the following statuses:

• Ready to Review
• In Review

Claim adjustments or line item status updates are reverted when you remove the payment posted to a claim.

1. Open the Remittance Details window for a remittance. See To navigate the Remittance Details window.
2. Click the Appliedtab.
3. In the Claim Number column next to the payment you want to remove, click the Remove icon.



A review window opens with remittance details for the payments.

4. To review the remittance details for the payment, click the Plus icon in the Remit Details column.
   If you remove a payment posted to a claim that has multiple applied payments, any payments applied after the payment you removed was applied also appear in the review window and are removed.
5. Click Yes.

   AcuityLogic removes the payment and moves the claim back to the Not Applied tab.

After you process all the claims for a remittance and apply the entire payment amount, you can post the remittance from the Remittance Details window.

1. Open the Remittance Details window for a remittance. See To navigate the Remittance Details window.
2. Click Post Remittance.
   You can click the Post Remittance button only if all the claims for the remittance are applied and the outstanding amount displayed above the status bar is $0.

   AcuityLogic posts payments for the remittance and changes the status to Posted.

   If the remittance includes more than 10 claims, AcuityLogic assigns a temporary Posting status to the remittance and posts payments for the remittance at scheduled times as part of an integration. After posting the payments, AcuityLogic changes the status of the remittance to Posted.