Claims Management Reports

The section includes information about the following Claims Management reports:

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.

Understanding the Report Filters

Use the report filters to control the data shown on the report. Two rules apply to how the filters are used:

  • Filter conditions are combined using AND logic, which means a transaction must meet every setting you select to be included.

    For example, selecting Carrier payment recvd for the Transaction Type and Exam for the Item Type will generate a report that shows only carrier payments for Exam line items. Carrier payments made on frame line items will be excluded, as will patient payments for exams.

  • For all filters except for Transaction Type, selecting All will cause the filter to be ignored during generation.

Selecting Data to Include on the Report

Use the report filters to select the Offices, Transaction Types, Carriers, Carrier Types, Accounts, and Item Types to include on the report.

When you select an office, the report will print information for claims associated with that office.

If you select All Offices Selected, the report will not use Office to filter the report data.

The transaction types available when generating the report are the transactions in (Undefined variable: Variables.ProductName5) and are defined below.

  • Net Current Billed
    • 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.
  • Payment
    • Carrier payment recvd: The payments against the insurance receivable.
    • Patient payment recvd: The payments against the patient receivable.
    • External claim adjustment: The amounts adjusted when a balance remains on a check with no existing claim. These adjustments are tracked by company instead of by office.
  • Auto Adjustment
    • 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 (Undefined variable: Variables.ProductName5). 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 (Undefined variable: Variables.ProductName5).

When you select a Carrier Name, the report will print information for claims for that carrier.

If you select All Carriers Selected, the report will not use Carrier Name to filter the report data.

Carrier Type is defined by whether the Prepaid Carrier check box is selected for the carrier in the Insurance Carrier setup window in Admin.

  • Third Party Insurance: Prints only carriers that do not have Prepaid Carrier selected.

  • Prepaid Insurance: Prints only carriers that have Prepaid Carrier selected.

  • All : The report will not use Carrier Type to filter the report data.

The accounts listed are the GL accounts configured in (Undefined variable: Variables.ProductName2). If a Billing Month close has been performed and exported to GL, only transactions associated to the selected accounts will be printed on the report.

If you select All Accounts Selected, the report will not use Account to filter the report data.

When you select an item type, the report will print information for claim line items with that item type.

Select Dates

Select this option to enter date ranges to print.

  • From Transaction Date/To Transaction Date: Filters transactions by the action date. For most actions, like adjustments, write offs, and line item edits on the claim, this is the date the action occurred.

    For carrier payment, patient payment, and external claim adjustment transactions, this filter behaves differently, depending on whether Eyefinity has set your system up to use the deposit date for payments. To change your setting, contact your account manager or Eyefinity Customer Care.

    • If your system is set up to use the deposit date, the associated payment's deposit date is used to filter the data.

      Example: A manual carrier payment transaction was made to a claim on September 20. The associated carrier payment’s deposit date is August 20. If you select a date range of September 1 through September 30, the payment will not be included on the report because the deposit date does not fall within this range. If you select a date range of August 1 through August 31, the transaction will be included

    • If your system is not set up to use the deposit date, the filter uses the transaction date for all transaction types.

      Example: A manual carrier payment transaction was made to a claim on September 20. The associated carrier payment’s deposit date is August 20. If you select a date range of September 1 through September 30, the payment will be included on the report because the transaction date falls within this range. If you select a date range of August 1 through August 31, the transaction will not be included

    • For ERA transactions, the filter uses the date the associated ERA was posted as the transaction date, not the date the individual claim was reconciled.

      Example: A claim was reconciled in the ERA module on August 20. The remaining claims 3 were reconciled and the Post button was clicked on September 5. All transactions will have a transaction date of September 5

  • From Service Date / To Service Date: Filters by the claim’s service date. This includes external claim transactions. These are optional fields and if not entered will be ignored.

Billing Month

The way the Billing Month filter is applied depends on the available Month Close data that is available:

  • If Month Close data is available for both the selected month and the prior month, the range is set from the prior month's close date to the selected month's close date, and only transactions linked to the selected month’s close are included. The CloseId will be for the selected month.

    Example: August is selected for Billing Month. July’s Month Close was run on August 2. August’s Month Close was run on September 2. The From Transaction Date will be set to August 2 and the To Transaction Date will be set to September 2. CloseId will be for August.

  • If either Month Close is missing, the range is set to the selected calendar month, and the CloseID is not considered.

    Example: August is selected for Billing Month. No month close was run for August. From Transaction Date will be set to August 1 and the To Transaction Date will be set to August 31.

Report Layout

The report appears differently depending on the selected criteria, but the following columns 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 (Undefined variable: Variables.ProductName5).

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

Use the Aged Claims Report to understand how long outstanding carrier or patient balances have been unpaid. The report analyzes billing transactions to categorize unpaid balances by age from the service date (30, 60, 90, 120, and 150+ days).

The report only includes claims with outstanding balances that have valid service dates. It excludes claims that are fully paid, have prepaid carriers, and/or have service dates that are in the future or are otherwise beyond the cutoff dates selected for the report.

Understanding the Report Filters

Use the report filters to control the data shown on the report. Filter conditions are combined using AND logic, which means a claim must meet every setting you select to be included.

For example, selecting VSP from the Select Carrier list and an office number from the Select Location list will generate a report that shows only VSP claims originated by that office. Claims for other carriers from that office, as well as VSP claims originated by other offices will be excluded.

Selecting Data to Include on the Report

Use the report filters to select the Carrier, Plan, Location(s), Patient, method to calculate the Total By, and Aging Type (Carrier or Patient), along with the billing month or date ranges to include on the report.

When you select a carrier, the report will print information for all claims associated with that carrier. If you do not select a carrier, and leave the field blank, the report will be generated for all carriers.

If you selected a carrier: the Select Plan drop-down list shows only plans associated with that carrier. If you do not select a plan, and leave the field blank, the report will be generated for all the carrier's plans.

If you did not select a carrier: the Select Plan drop-down list shows all the plans in your system, for all carriers. Leave the field blank to generate the report for all plans. If you select a plan from the list, the Select Carrier field automatically updates with the associated carrier.

All offices in your company are listed in the Select Location drop-down list and are selected by default. Deselect any offices you do not want to include on the report.

When you select a patient, the report will print information for claims associated with that patient. If you leave the field blank, the report will include all patients with claims that match the other filter criteria.

Select how you want to view the report totals.

  • By Location By Carrier: Shows outstanding balances listed by carrier and grouped by office.
  • By Carrier: Shows outstanding balances listed by carrier.
  • By Claim: Shows outstanding balances listed by 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 list:

  • All: Includes all claims with carrier and patient outstanding balances
  • Carrier Only: Includes claims with outstanding carrier balances only (Ready to Bill or Billed status).
  • Patient Only: Includes claims with outstanding patient balances only (Ready to Bill Patient or Billed to Patient status).

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

Select Dates

Select this option to enter date ranges to print. Allows you to select dates from the Cut Off Date, Last Deposit Date, and From/To Service Date fields.

  • Cut Off Date: Transactions completed up to this date are included on the report. Transactions after this date are excluded. This field defaults to the current date.

  • Last Deposit Date: Deposits made up to this date are included on the report. Deposits after this date are excluded. This field defaults to the current date. ERA payments are included only if they have posted.

  • From Service Date: Claims with service dates on or after the date you enter are included on the report. Leave this field blank to include all claims in your claim history (no start date filter).

  • To Service Date: Claims with Service Dates up to this date are included on the report. Claims with Service Dates after this date are excluded. This field defaults to the current date.

Billing Month

Allows you to select a billing month. This field defaults to the current month but you can change it.

The way the Billing Month filter is applied depends on the available Month Close data that is available:

  • If Month Close data is available for both the selected month and the prior month, the range is set from the prior month's close date to the selected month's close date, and only transactions linked to the selected month’s close are included. The CloseId will be for the selected month.

    Example: August is selected for Billing Month. July’s Month Close was run on August 2. August’s Month Close was run on September 2. The From Transaction Date will be set to August 2 and the To Transaction Date will be set to September 2. CloseId will be for August.

  • If either Month Close is missing, the range is set to the selected calendar month, and the CloseID is not considered.

    Example: August is selected for Billing Month. No month close was run for August. From Transaction Date will be set to August 1 and the To Transaction Date will be set to August 31.

Report Layout

The report appears differently depending on the selected criteria, but the following columns remain consistent.

Column Description

Total

The total unpaid amount.

Current

The unpaid amount for services dated within the last 30 days.

30 Days

The unpaid amount that is 30 days past due.

60 Days

The unpaid amount that is 60 days past due.

90 Days

The unpaid amount that is 90 days past due.

120 Days

The unpaid amount that is 120 days past due.

150+ Days

The unpaid amount 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.