This document reviews the processes for posting carrier payments. Carrier payment details are included in either the paper EOB, which must be manually updated, or via an electronic remit (ERN), which imports the data automatically from the clearinghouse.
Importing ERNs is not the same as receiving payment through ACH directly to a bank account. ERNs include details on each charge, which are imported into software. ACH payment is a direct payment that should match an ERN (or EOB).
If you do not have any Unprocessed ERNs or Unapplied Checks, those menu items will not appear.
The next two sections, Processing ERNs and Processing EOBs, show how to select charges for processing in Carrier Payments. The Carrier Payment process is the same for both and are explained in the remainder of the document.
Processing ERNs
Go to your Trizetto account and look at the matching EOBs.
ERNs are automatically added. If the list doesn't match what you see on Trizetto, click Reprocess ERN File to update the list
Clicking the + Sign next to each row opens detail about the ERN and each claim
To begin processing an ERN, highlight the row in the upper portion of the window and complete the information in the bottom section. Click Process.
The Carrier Payment window is the same for ERNs or EOBs
Processing EOBs
Put a check in the Find all carrier charges for the date range regardless of status to include all patients and charges in the date range for this carrier to show all potential claims that belong to the EOB
If one charge for a date of service is being paid, even when there are multiples that were submitted, click the + sign to choose the specific charges to include
The Carrier Payment Window
The Carrier Payment window is the same for ERNs or EOBs
Only fields in white can be modified to match the ERN/EOB information to this window
| Icon/Button | Description |
|---|---|
| Save | Save while processing the ERN |
| Save and Close | Save and close the current window |
| Cancel | Cancel all changes |
| Apply Check | After you update each line item, choose Apply Check to process the check |
| Delete Check | Delete a check that has not been applied. If it has been applied you must void it |
| New | Start processing a new Carrier Payment |
| Refresh | Refresh the window |
| Carrier | The master carrier assigned to this payment |
| Credit Card Icon | Click this to enter payment via credit card. Carrier card payments are entered manually |
| Amount | Enter the total amount of the payment |
| Unposted | The remaining amount of the payment |
| Check Date | Enter the date of the check |
| Ref# | The ERN reference number or the check number |
| Notes | Enter any notes to help describe the carrier payment |
| Default Payment Method | This is brought over from the prior window. Update as necessary |
| Default Adjustment Method | This is brought over from the prior window. Update as necessary |
| Select Charges | Charges are automatically selected for ERNs, but must be manually selected for EOBs (see below for steps) |
| Utilities |
|
| Write Off All Balances | Click this to write off any remaining balances |
| Expand All | Expands each claim to show all of the charges |
| Total Progress | The progress bar turns green as you work through the carrier payment to show how much is complete |
If you need to adjust the check amount for any reason, select the reason from the default adjustments shown in this window
Check Adjustments
When your carrier takes back or pays additional funds causing your check not to balance, you will need to enter a Check Adjustment. Go to Utilities and select 'Check Adjustments'
For Interest/Additional payment select 'Add New Credit' and for Insurance Recoupments/Takebacks, select 'Add New Debit'
After processing a Recoupment/Takeback and applying your check, you will need to issue the insurance refund within the patient ledger. See document below for how to issue the refund from patient ledger https://help.healthcoretech.com/a/1705737-adj-write-off-refund-reasons
Red Flag Functions
Blue Flag Functions
Enter a Credit Card for Payment
If the carrier issues payment in the form of a credit card, click the Credit Card icon to process the card number manually.
After payment is entered, click Apply Check to complete the process.
After you process the primary payments, the remaining charges will go to secondary or patient responsibility. See the document on processing secondary claims for more information on that process.
Unapply or Void a Check
There are two reasons to either unapply or void a check:
- If the check is duplicated. For example, you processed the EOB and then received the same information in an ERN
- If you processed the check but the money received doesn't match what was previously entered
Edit a Check
There are multiple reasons you may want to edit a check:
- If you didn't finish applying the EOB/ERN, go to Unapplied Checks on the Billing menu and select the check to continue the process
- If you have applied a check and need to go back and fix the check, access the check from the Billing Location Ledger-Checks tab
- If you have applied a check and need to go back and fix the check, access the check from the Patient Ledger
Finish Applying EOB/ERN
Billing Location Ledger
Patient Ledger
