Claims Management Reports

The section includes information about the following Claims Management reports:

Billing Transaction Report
Monthly Aged Balancing Report
Aged Claims Report
POS Billing Reconciliation Report

To access these reports, click Billing Reports in Claims Management.

For these Claims Management reports, the date range used when you select the Billing Month option is the first day of the calendar month through the last day of the calendar month. For example, the billing month of June would be June 1st through June 30th.

Billing Transaction Report

The Billing Transaction Report provides details for each transaction by claim. This report is typically generated with all carrier types and all item types selected.

The transaction types available when generating the report are the transactions in Claims Management and are as follows.

Net Current Billing
- Claim billed: The expected insurance receivable.
- Claim sent to direct billing: The expected patient receivable (Bill to patient).
- Manual claim deletion: The claim edits to delete a line item (Adjustment).
- Manual claim addition: The claim edits to add a line item (Adjustment).
- Manual claim update: Any changes to the patient or insurance receivable.
- System adjustment: The receivable changes based on internal rules such as Billing Rules. These adjustments are system-created transactions.
Payments
- Carrier payment recvd: The payments against the insurance receivable.
- Patient payment recvd: The payments against the patient receivable.
- External claim adjustments: The amounts adjusted when a balance remains on a check with no existing claim. These adjustments are tied to the company and not particular offices.
Auto Adjustments
- Refund adjustment: Any refund against the insurance or patient receivable. For example, a returned frame would be an adjustment against the insurance receivable.
- Remake adjustment: Any difference in the patient or insurance receivable by line item.
  If a line item is on hold when you issue a refund, the system creates a remake adjustment. If a line item is not on hold, the system creates a refund adjustment.
Write Off
- Carrier AR write off: The adjustments where all or a portion of the insurance receivable is written off.
- Patient AR write off: The adjustments where all or a portion of the patient receivable is written off.
Post Billing Adjustment: The adjustments made in Claims Management. Examples of these adjustments include Keep Overpayment, Receivable Adjustment, or Special Batch Adjustment.
Claim Sent to Collections: The adjustments that occur when a claim is sent to collection in Claims Management.

The generated report appear differently depending on the selected criteria. However, the following columns in the generated report remain consistent.

Column	Description
Trans ID	The system-created transaction ID number.
Order ID	The order number.
Claim ID	The claim number.
Payment Number	A payment number entered by the user. This is typically a check number.
Patient Name	The patient name on the claim or order.
Adjustment Reason	The adjustment reason selected in Claims Management.
Service Date	The service date on the claim.
Deposit Date	The deposit date entered by the user for the check.
Ins Amount	The amount of the insurance receivable paid, written off, or adjusted.
Pat Amount	The amount of the patient receivable paid, written off, or adjusted.

Monthly Aged Balancing Report

The Monthly Aged Balancing Report provides an analysis of receivables per office by category. The date range used when you select the Billing Month option represents the calendar month.

Column	Description
Office Num	The office number.
Beginning AR	The starting receivable for the selected billing month. This value typically equals the ending receivable for the prior month.
Net Billed	This amount includes Claims Billed to Insurance, Claims Billed to Patient, Manual Claim Deletions, Manual Claim Updates, Manual Claim Additions, and System Adjustments.
All Payments	This amount includes Insurance Payments and Patient Payments.
Auto Adjustment	This amount includes Refund Adjustments and Remake Adjustments.
Writeoff	This amount includes Write Offs and Patient Write Offs.
Adjustment	This amount includes Post Billing Adjustments.
Collections	This amount includes Claims Sent to Collection from Claims Management.
Ending AR	Ending AR = Beginning AR + Net Billed + All Payments + Auto Adjustment + Writeoff + Adjustments + Collections

Aged Claims Report

The Aged Claims Report lists balances (amounts owed to your practice) by age (30, 60, and 90 days) for the selected carrier, plan, location, and/or patient.

To filter the report and narrow the report’s results, select options from one or more of the following drop-down menus:

Select Carrier
Select Plan
Select Location
Select Patient

With the Total By drop-down menu, you can view the report totals by:

Location and carrier (which creates a summary report)
Carrier
Claim

To filter what types of claims are included in the report, select one of the following options from the Select Aging Type drop-down menu:

All
Carrier Only: Includes claims with an outstanding insurance receivable.
Patient Only: Includes claims with a Ready to Bill Patient and Billed to Patient status. (The balance moves from Carrier to Patient when the status changes to Ready to Bill Patient.)

To set a specific time frame for the report, select one of the following options:

Select Dates: Allows you to select dates from the Cut Off Date and Last Deposit Date fields.
Billing Month: Allows you to select a billing month.

The following information is provided in the generated report.

Column	Description
Total	The total amount owed.
Current	The current amount owed.
30 Days	The amount owed that is 30 days past due.
60 Days	The amount owed that is 60 days past due.
90 Days	The amount owed that is 90 days past due.
120 Days	The amount owed that is 120 days past due.
150+ Days	The amount owed that is over 150 days past due.

POS Billing Reconciliation Report

The POS Billing Reconciliation Report shows you what was billed and what has changed. With this report, you can see the variance between the changes made to the AR balances in Front Office and Claims Management.

When you generate the report, you can select one of the following AR options:

Re-billed Claims: Claims that go from the carrier to the patient and back to the carrier.
Manual Billing Updates: Billing updates that are made manually. (This can include deletions.) You can also see manual billing updates in the Billing Transaction Report. See Billing Transaction Report.

To set a specific time frame for the report, select one of the following options:

Select Dates: Allows you to select dates from the From Transaction Date and To Transaction Date fields.
Billing Month: Allows you to select a billing month.

The following information is provided in the generated report.

Column	Description
Order	The order number.
PatientName	The name of the patient.
ServiceDate	The date the service was rendered.
CarrierName	The name of the insurance carrier.
PlanName	The name of the insurance plan.
A/R Net Billed	The amount billed in Claims Management (both insurance and patient AR). The amount depends on what you selected from the A/R Options drop-down menu when you generated the report.
A/R Posted From POS	The insurance amount covered for the claim in Front Office.
Variance	The difference between the A/R Net Billed amount and the A/R Posted From POS amount.