Insurance Payments

Important: This section is for entering and allocating insurance payments manually. If purchased, axiUm can also handle insurance payments automatically through the Auto Remittance module.

Insurance payments are made by insurance companies on behalf of a patient or guarantor that has coverage so that the patient does not have to pay the entire cost of their treatment. Depending on the type of coverage and the procedures completed, the insurance company may cover part, all, or none of the cost. After services have been rendered to a policy holder or their dependent and submitted within a claim, the insurance company sends back payment to pay for their portion of the charges and an Explanation of Benefits (EOB) document, outlining how much money should be applied to each treatment in the claim.

Tips:

  • A claim may contain multiple treatments for a single patient.

  • Insurance companies often send a bulk payment to cover multiple claims and multiple patients. An insurance payment is handled the same regardless of how many patients and treatments are included on a single payment.

  • Even though the full charge amount is sent to an insurance company on a claim, a company may pay a partial amount or no amount at all. The EOB will be used to allocate the insurance payment amounts to the correct treatments.

    • Examples: The coverage template is out of date or the insurance limits were reached.

  • Insurance companies entered into axiUm may be parent or child companies. A parent company is a larger company that is a collection of child companies. Claims can only be submitted to child companies, but you may receive payments from parent companies.

Once received, insurance payments are added from the Transactions module > Insurance Payment tab and allocated as necessary. Allocation identifies which patient record the payment will be applied to as well as which treatments and charges.

If an insurance payment that does not match the amount submitted, the remaining treatment balance must be handled in one of three ways: transferred back to the patient, transferred to another insurance, or be written off.

Tip: If necessary, you can complete a combination of these tasks. The Balance field should display 0.00 when you apply all transfers and write offs.

Important: If insurance overpaid, you need to rebill the treatment.

In the cases where an insurance company sends back a $0 payment for a claim or includes a treatment that they paid $0 for, the balance on the claim must be dealt with after the payment is added. Depending on the situation, the balance may be transferred to a secondary or tertiary insurance coverage, transferred to the patient, or written off by the institution.

You can perform a variety of tasks to help you manage insurance payments.

This can include: