Piecemeal Payment Events

There are many situations requiring a biller to create a payment event by hand. This guide explains how to do it.

Before continuing, be sure you understand how AngelTrack calculates the balance due.

Paper accounting

Are You Entering Paper EOBs?

If you are regularly entering paper EOBs received from insurers, contact your clearinghouse and sign up for electronic ("EDI") documents. AngelTrack can process electronic insurance documents for you, saving you the enormous hassle of manual data entry.

To learn how electronic claims and electronic EOBs work, read the EDI Primer. To learn how AngelTrack can automatically transfer your electronic claim batches up to your clearinghouse, and pull down all electronic replies from the clearinghouse and carriers, read the Clearinghose Uploader/Downloader Guide. To learn how to import an electronic EOB into AngelTrack, read the Importing X12.835 EOBs Guide.

Finding the dispatch ID on a paper EOB

AngelTrack's claim control numbers are distinctive, and so are easy to find on a paper EOB:

EOB with claim control number

This is assuming you used AngelTrack to code and file your claims; if you used a different billing application, then consult that application's help to learn what its claim control numbers look like.

To learn more about how to read a paper EOB, including how to find the AngelTrack dispatch ID, check out the Reading an EOB Guide.

Paper EOBs are Problematic

Entering paper EOBs is drastically less efficient than using electronic EOBs. If you are entering more than a small percentage of your EOBs manually, call your clearinghouse and ask to be switched to electronic statements.

Manually-entered payment events have all of these drawbacks:

  1. Typographical errors
  2. Accidental duplications
  3. Incorrect "next steps" decisions (see "The 'Next Steps' Decision" below)
  4. Cannot electronically file any secondary claims unless the whole chart of CARCs is manually keyed in

Locating the Dispatch Record in AngelTrack

Payment events are always associated with dispatch records. Therefore to record a payment event you must first locate the dispatch record that incurred the payment.

Finding a dispatch record when you know its ID

The quickest way to retrieve a dispatch record, when you already know its dispatch ID, is to use the search-box. Simply press ALT+G from any AngelTrack dispatch-side webpage (i.e. not from AngelTrack's crew areas), or click the magnifying-glass icon in the top-bar on the right. The search box will popover the current page, without disturbing your work there. Type in the dispatch ID, but don't hit ENTER; instead, press the 'A' key. The search-box will then open the Payment Event Add page for you.

Although the Firefox web browser is not officially supported by AngelTrack, if you use it anyway, you may discover that the ALT+G shortcut doesn't work. Instead you must click the magnifying-glass icon from the top-bar at the right.

Finding a dispatch record when you know the patient record

If you already know the patient and have their patient record open, just switch to the "History" tab. It will show all of their transports, going as far back in time as you wish. Or use the "Receivables" tab, which shows just those transports with an outstanding balance.

Finding a dispatch record when you don't know its ID or its patient record

The Record a Payment Page has a combination of filters for rapidly locating any dispatch record. You can search by date range, patient name, dispatch ID, origin facility, patient date of birth, and service level. In the result grid you can click the $ icon to add the new payment event.

For example, suppose you are entering the data from a paper EOB. EOBs often list all services rendered to a patient over a period of time. In such cases, use the patient name and DOB fields to find all the patient's dispatches, and then use the 'Date of Service' filters to zoom in on just those dispatches covered by the EOB.

EOBs from Medicare and Medicaid often include the combined HCPCS code for the transport; for example, transport from a hospital (HCPCS code H) to a skilled nursing facility (code N) is listed as 'HN'. On the Record a Payment Event page, the list of dispatches includes the combined HCPCS code for each item, shown next to the service level. (If you don't see these codes listed for your dispatches, then you need to edit your Facility records and set their HCPCS codes.) The combined HCPCS code makes it easy to tell the difference between an outbound trip (e.g. NH) and the return trip (HN), which is otherwise difficult to tell just by looking at a typical EOB.

Recording the Event

The Payment Event Add page shows you the following data about the underlying receivable (i.e. about the dispatch); some of them can be edited:

For the new payment event you are creating, the following fields are offered:

Once entered, click 'Save'. The window then changes to an acknowledgement screen, showing a table of all recorded payment events for the dispatch. Use the table to check your work before proceeding.

Associated Check or EFT

In this group of fields, you will input the details of the check or EFT that accompanied the adjudication, so that AngelTrack can place it into your Check Register.

You must input the full amount of the check/EFT -- not just the amount that was applied to this particular dispatch. That way, AngelTrack can create a single record in the Check Register, and then link all associated payment events to it.

As soon as you input the check/EFT trace number, AngelTrack will see if it's already in the Check Register. It will tell you whether or not it found a match.

If you are inputting many adjudications all connected to one check/EFT, then for each adjudication after the first one, you must input the same check/EFT and verify that AngelTrack finds it. That way, your Check Register will be neat and tidy, with no duplicates, making it easy to compare against your bank statements.

To learn more, read the Check Register Guide.

Interest paid

If you include an interest payment with the adjudication, AngelTrack will add the interest to the relevant check-register entry as a PLB (aka "provider-level adjustment")... same as though it'd been reported to you in an X12.835.

If you make a typo, you can go to the Check Register, find the check you created, review its PLBs, and make corrections as necessary.

If the EOB specifies an interest payment but does not associate it with any particular claim, you can still post it in AngelTrack. Just include it when you are recording the last adjudication from the EOB. AngelTrack will associate the interest payment to that particular dispatch, but it won't hurt anything.

Entering the Claim Adjustments Chart

If the primary carrier sends only paper EOBs, but the secondary carrier requires an electronic claim, then you must input into AngelTrack the entire chart of the primary carrier's adjustments:

EOB with CARCs highlighted

In the Add Payment Event page, below where you select the payor, click the link "Input the adjustments from a paper EOB, for use in filing an electronic secondary claim" to open the chart of service lines, which looks like this:

CARC chart

Enter all of the adjustments into the little tables at right, being careful to match up the service lines, and double-checking your numbers. The data will then be saved with the payment event, and thereafter used to emit any secondary claims where the carrier needs to know what adjustments the primary made.

If you make a mistake and need to edit your work, simply click the payment event to open the Payment Event Edit page, switch to the "835 Decoded" tab, and make the necessary adjustments.

Remark codes / RAR codes

This field is for listing the RAR codes ("RARCs" or "remittance advice remark codes") returned by insurers. These are sometimes listed on EOBs under the heading "MOA". They all begin with 'M', 'MA', and 'N'. They explain the reasons for adjustment or denial. Just type them in separated by spaces; afterward, AngelTrack will automatically look up and display their meanings. RAR codes caused by missing documentation or coding errors will be highlighted in yellow, and will automatically raise the yellow exception flag Yellow flag.

The remark code MA125 is special, as it voids any PR amounts as statutorily prohibited from being collected from the patient. When MA125 is present, AngelTrack regards the PR amount as zero.

The "Next Steps" Decision

Many payment events will trigger a change to the dispatch's Postprocess Status, or to its Payor, or both. AngelTrack offers to make this decision for you, either semi-automatically (where you review it afterward), or fully automatically, or showing you the recommendation and letting you click the buttons to implement it if you agree.

If you choose to manually decide the next step, here is a primer on the most common situations requiring a change:

Insurance Pays, Copay Still Due

When the received payment covers the insurer obligation and all that remains is the copay, then move the dispatch to 'Billing Office' and change the payor to 'Patient'. This will cause the dispatch's remaining balance due to show up on the next batch of patient invoices.

Workflow loops

The Invoice Generator for Patients will then push the dispatch forward to 'Awaiting Payment' once the proper invoice is generated and committed. (further reading)

Insurance Pays, No Copay Due

When the received payment covers the entire balance due (e.g. patient has no copay), then move the dispatch to 'Finished'.

Workflow loops

Primary Insurance Approved, but Failed to Forward to Secondary

When the primary insurance carrier approves the claim but fails to automatically forward to the secondary, then you must file against the secondary yourself. Send the call back to 'Billing Office', and keep the Payor set to 'Insurance', so that the call will reappear in the Insurance Filing Queue to be batched up for the secondary carrier.

In order to do this, you must type in the table of CARC adjustments from the primary carrier's EOB, as illustrated above. This data is required by the secondary so that they can account for the primary's discounts and adjustments.

Workflow loops

In this situation, AngelTrack will automatically switch the associated dispatch's coding target from the primary carrier to the secondary. The dispatch will reappear in the Insurance Filing Queue to be batched up for the secondary.

Insurance Denial

When denied by insurance and in need of resubmission to the insurance company or to a different insurance company, then move the dispatch to 'Billing Office'. It will then appear in the Insurance Appeal Queue.

Workflow loops

Insurance Final Denial, Bill to Facility

When denied by insurance and therefore the responsibility of the facility, then move the dispatch to 'Billing Office' and change the payor to 'Facility'. This will cause the dispatch's remaining balance due to show up on the facility's next invoice.

Workflow loops

Insurance Final Denial, Bill to Patient

When denied by insurance and therefore the responsibility of the patient, then move the dispatch to 'Billing Office' and change the payor to 'Patient'. This will cause the dispatch's remaining balance due to show up on the patient's next invoice.

Workflow loops

Full Cash Payment

When processing a full cash payment from a patient, simply push the dispatch forward to 'Finished'.

Workflow loops

Remember that when cash-pay dispatches graduate QA (or skip it), they advance immediately to 'Awaiting Payment'. They do not stop at the billing office first; rather, they assume the driver has already collected the money and will turn it in at the station for processing. (further reading)

Partial Cash Payment

When processing a partial cash payment from a patient, and the payment does not cover the entire balance due, then move the dispatch to 'Billing Office' if you want to re-invoice the patient for the remainder:

Workflow loops

If, on the other hand, you plan to simply wait for the patient to send in the balance, then leave the dispatch at 'Awaiting Payment'.

Write Off the Balance Due

When you give up attempting to get paid for the dispatch, you can write it off by simply moving it to 'Finished'. Its uncollected balance will thereafter show up in AngelTrack's tax reports.

Workflow loops

You can do this at any time, regardless of what billing activity has already been done. And you can always record additional payments, or move it back to 'Billing Office', whenever you wish. The only requirement for advancing a dispatch to 'Finished' is that it must have a price quote. The price quote is used to calculate the tax writeoff. To learn more about tax calculations, read the Taxes and Collections guide.

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