Reconciling EFTs from Insurance Companies

[suzanne]

Does anyone have an efficient method of tracking, matching, and reconciling their Insurance EFT payments?  Since most of our Insurance payments are through EFT now, this process is becoming a monster and taking way too much time to get payments posted. 

I need to ensure that what is posted in Softdent is what is deposited into our bank account, since we had a fiasco in 2016 when suddenly United Healthcare started sending our payments to a different bank account who was a private citizen unrelated to the office.  On Saturdays, I post all payments that were deposited into our bank account for the week.  However not all companies fax/email an EOB, so I have to check the bank account first and then go to each company's website to download a copy of the EOBs.  On top of that, some companies do not have EOB information on their website if we are not contracted or an out-of-state provider.  For those companies I actually have to call and have a representative email me the EOBs. 

And with the upsurge in network leasing and changing TPAs, some of the names on our bank statement aren't the actual company that made the payment.  So it becomes a cat and mouse game.  For example, our bank statement shows an EFT from BCBS Georgia.  I called BCBS Georgia which has no record of payment to us.  They said it could be from one of the companies that they administer, but not actually underwrite.  Without having the patient name (since we didn't have an EOB), this took another 3 departments, multiple transfers, and 2 more weeks of research to find who the payment was for!  This creates a problem when the deposit was in a previous month and I have to backdate the system to post the payment, then re-run all Final Daysheets and Month-End reports.

Also, the Delta Dental Individual Plans don't have the EOBs available on the National website.  I asked if we could get paper checks and EOBs for those patients.  They said since we are signed up with Delta Dental's National EFT program, we can't pick and choose which companies to get paper checks from.  So the solution is that I have to call to get the EOBs emailed to me.  And for those of you who have had to call an insurance company for anything other than simple benefits, you already know it's about a 30-minute process to get through the menu system, wait on hold, and finally get to someone who has the information you need!

[drcavola]

As I mentioned, we get the faxes of EOB's from Metlife.  It's pretty straightforward from there.  Today, for instance, we got two MetLife EFT's posted to our bank account.  One for $388.50, and another for $1021.60.  Since the amounts are unique, it's pretty easy to determine who's is who's from the stack of EOB's ... there are identifiers associated with the EFT, but normally we don't need to delve that deep.  Yes, occasionally we'll see three of the same amounts ... if there are three in the ques then great.  I'd say about 95% of the time we don't have to play "inspector" with our EFT's.  It works for us ... I wish it was the same with everyone else.

[elavid]

I was informed that if you weren't signed up for EFT's before a specific time frame, the EOB's would NOT be sent to you via fax. I had mentioned this to the representative at Metlife when inquiring about signing up for EFT's. Through previous experience with a different office, I knew that the EOB's would arrive via fax every morning and that is how I wanted to receive notification of a payment being post for a particular patient. However, when speaking with that representative she said that they no longer send EOB's via fax unless you were "grandfathered" in. Everything now would come via logging into their website to get the appropriate EOB. Our office did not sign up for EFT's because of this.  

[doctom4300]

Based on our experience with getting EFT payments from Metlife, switching to getting the EOBs via fax would not convince me that everything was accurate. I would still have to double check everything.

[suzanne]

Brenda: That's interesting that you've had such a bad experience with Metlife.  For us, Metlife has been the ONLY company we've never had a problem with.  Their claim processing is consistent, our provider portal is easy to navigate and always up-to-date, and the money is always in our bank account when it says it is.  We've been getting EFTs from them since 2007.  The only difficulty I've had with them is that our Provider Rep is no longer with the company.  I spent months trying to ascertain who our new Provider Rep is and was transferred all over the world and through multiple departments, dropped calls, emails, sweat, and tears...and still no response from our "new" Provider Rep.  In the end, I gave up since a direct fax got the results I wanted.  It was just a little disconcerting that I couldn't actually talk to our "person" to hold anyone accountable for doing the job.  

[Anon]

Thanks Dr Cavola, I am going to add a TIP

under the bank number I enter the carrier in Caps ie: METLIFE

Under the Check Number I enter the EFT Transaction #

in the notes I enter the DOS and a short note 

You can also print the Transactions for a period for code 2.90 with your desired date range. This reports will list all of the EFT payments you posted.

**** see below eft‌tyson.edwards

This was posted 1 year ago, I do not know when it will be available, but it will be a huge help when it comes to  balancing your EFT payments.

[suzanne]

Wendy: Yes, I also enter the EFT Transaction # in the Check # field, and the CARRIER in the Bank # field.  If employees see a bank # that is LETTERS instead of numbers, that is their red flag that the payment is an EFT instead of a check and needs to be recategorized before final Daysheets are run.

[pksaari79]

We don't take EFT's.....we ask for a paper check to which they have always given us. And lately, knock on wood, no one has told us we have to do this - for awhile Metlife told us we had to but when I called, I was told we did not have to do that. It is for this reason, your fiasco, that I do  not want to take EFT's.  And we are not contracted so our support would not be as good I do not think.  Sorry, I can't help you......:(

[suzanne]

Hi Kay,

I was trying to avoid mentioning the other fiasco we've had, which was employee embezzlement of $95,000 and the reason we were trying to go to all EFTs.  But perhaps that is relevant information as to why I am suffering through this EFT process and trying to make the best of it!

[lakegirl]

Suzanne, how was that caught? the embezzlement? and what have you done to rectify? 

[suzanne]

Softdent is really lacking in appropriate security and other measures for checks and balances, so I probably shouldn't go into the embezzlement detail on this forum.  Rectifying and/or preventing future occurrences has been difficult due to the additional issues with simply matching up EFTs with bank statements.  When one method of payment doesn't rectify, it tends to have a domino effect.  I'm going into the third year of fixing this problem.

[danelle_canales]

Wow, this is amazing information - some of which I wasn't even aware of... I'd love to help, but because I'm not in an office everyday I'm not sure I have the correct best practices to share with you.  Tagging some others to see if anyone can lend us some advice.  

softdentgirl‌, pksaari79‌, mdunham‌, dr.cavola‌, barbhouser‌, doctom4300‌, bert‌,