Payment Actions

In the bottom lower part of your screen you will notice a drop down box with the word Action: next to it. There are several action functions that can be performed while in the Payment Entry Function. These functions are performed by clicking the box in the Action (Act) column for each procedure(s).

Once you have clicked on a line item, the Action drop down box will become active and you may select the desired action. You can only do one type of action at a time, but may click on several line items for that action. Each of these functions will occur even if the payment is not saved. NOTE: These functions will not display if there has never been an insurance carrier on the account.

The Payment Actions were designed to be transparent during the payment entry process to minimize interruptions to the normal workflow. If a payment and adjustment are posted together during payment entry and a Payment Action is also performed, only one notation for the Payment Action is made in the patient's Insurance Ledger.

The following actions are available:

• Reset - Reverses a Payment Action and the corresponding notation in the patient's Insurance Ledger. It is also used to clear a line item that you mistakenly applied a payment, adjustment, or denial towards. Select the Act check box for the transaction in the Act column, then select Reset from the Action list. The screen refreshes and any line items checked will have their payment, adjustment, or denial amounts removed, and the balances at the top of the screen are adjusted accordingly. Reset will only work on the active line items within the current Payment Entry screen, prior to saving the payment.
• Pend - Holds a charge so it continues to show up on insurance aging reports until further action by the insurance carrier is taken (i.e., payment or denial). Click the line items you want pended, then select Pend from the Action list. A dialog box displays with the carrier defaulted, a drop-down of all other carriers on file, and a reason box for a free-text explanation. You may want to pend a procedure if insurance has requested additional information. When you run Create Delinquent Insurance (Billing, Insurance Billing Functions, Delinquent Insurance Menu) you can opt to have pended charges suppressed from creating a delinquent claim. You can also run a report of all charges currently in a pend status– see Pend Reports (Billing, Insurance Billing Functions, Insurance Management Reports).
• Refile - Refiles the selected charge(s) to the patient's insurance carrier. Click the line items you want refiled, then select Refile from the Action list. A dialog box displays with the carrier defaulted, a drop-down of all other carriers on file, and a reason box for a free-text explanation. A 'Refiled' code (*) is placed in the insurance status field and the transaction is immediately placed into the insurance submission file.
• File - Files the selected charge(s) to the patient's insurance carrier. Click the line items you want filed, then select File from the Action list. A dialog box displays with the carrier defaulted, a drop-down of all other carriers on file, and a reason box for a free-text explanation. If the charge passes the edits for filing, an 'E' (electronic) or 'F' (paper) is placed in the insurance status field and the transaction is immediately placed into the electronic or paper file.
• Transfer - Transfers a balance between the insurance and patient columns. Click the line items you want transferred, then select Transfer from the Action list. The dialog box below displays with the carrier defaulted, a drop-down of all other carriers on file, a reason box for a free-text explanation, a Transfer To option (Patient Balance or Insurance Balance), and a Transfer Amount.
  
  If you have selected multiple line items, you will have to select whether or not you want the balances transferred to patient responsibility or to insurance liability. You can select the desired outcome by clicking the appropriate radio button next to your selection. All balances will be transferred to the column you selected whether they are credits, debits, charges, payments, or adjustments. If you select only one line item, you must enter the amount you would like to remain in patient balance. If you enter an amount that is less than the amount owing on the line item, then the remainder will be put in the insurance balance.
  
  You must be aware that when a patient balance is transferred to insurance CGM webPRACTICE does not automatically bill the insurance carrier. In order to bill the insurance you must file the procedures either through the re-file or file function on this screen, or through the insurance on demand. This function can be helpful in correcting insurance billing errors (i.e., the insurance carrier has only made a partial payment on a claim and you want to re-submit the claim entering a transfer after posting the payment will keep the amount in the insurance balance).
  
  
  

• Co-pay - Causes the co-payment amount to remain in the Patient Balance column when the insurance is billed (normally done when the patient didn't make their copayment), so CGM webPRACTICE can generate a statement for the unpaid co-payment. Click the line item, then select Copay from the Action list. A dialog box displays with the carrier defaulted, a drop-down of all other carriers on file, and an amount box defaulting to the co-payment amount stored in the patient's primary insurance record. Accept the amount with Tab, type a corrected amount, or type the corrected amount followed by an asterisk (*) to post a different amount and also update the co-payment amount in the patient's Insurance Information (e.g. 10.00*).
• Unpend - Reverses a Pend. Click the line item(s) you want to unpend, then select Unpend from the Action list. The pended status is removed so the charge(s) are no longer held back from delinquent insurance processing.
• Force to Insurance Balance - Overrides the automatic shifting of balances and moves the balance for the selected line item(s) into the insurance balance column.
• Force to Patient Balance - Overrides the automatic shifting of balances and forces the balance for the selected line item(s) into the patient balance column even when the patient has a secondary carrier.
• Suppress Secondary - Leave in Ins. Bal. - Suppresses the generation of a secondary claim and leaves any balance remaining in the insurance balance column.
• Suppress Secondary - Force to Pat. Bal. - Suppresses the generation of a secondary claim and forces any balance remaining into the patient balance column. A notation of Transfer from Ins, Suppress Secondary. is made in the patient's Insurance Ledger for the transaction.