Making Remittance Adjustments

You can make 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 will need to create a remittance adjustment for the amount of the bonus.

To simplify the remittance posting process, you can create insurance payment rules in Administration to automatically adjust or write off underpaid claims. When a remittance is downloaded to Encompass, the payment rule created for its carrier is applied to any underpaid claims in the remittance, which the system then automatically adjusts or writes off according to the rule. For more information, see Setting Up Payment Rules for Electronic Remittances.
  1. On the top menu bar in Encompass, click Claim Management and select Claim Management.
  2. On the top menu bar in Claim Management, click Process Payments and select Electronic Remittance Payment.
  3. Search for a remittance with the Ready To Review or In Review status. For more information on searching for remittances, go to Searching for Remittances (ERA).
  4. Click the link for the remittance in the Remittance # column.

    The Remittance Details screen opens. The Not Applied tab includes all the claims in the remittance that need to be processed.

  5. Click + Remittance Adjustment.

    The Remittance Adjustment window opens.

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

    Encompass adds the adjustment to the Remittance Adjustment tab.

    Click Edit to update remittance adjustment information or click Delete to delete the remittance adjustment.