Reconciling EFTs from Insurance Companies

[softdentgirl]

V17 is ready!  Changes are coming.

[suzanne]

I agree Ron, the "reversals" are a nightmare!  Especially when they re-correct the reversal on a completely different EOB in a different month.  Or if the insurance company takes it out of a completely different subscriber!

[jojob]

Kevin,

re:  Humana EFT payments.  Sign up with the Humana provider website (https://humana.com). 

We are a non-contracted provider but we can sign onto the Humana website to get details of our claims & payments. On a day when I see a Humana deposit in our checking acct, I log onto Humana and put a date range of payments, ex: recent 2 weeks.  It will list any claims' payments processed during that period.  I just look for that $26.40 payment and there's the EOB.  So, then I can post $26.40 to the correct Softdent patient.  I never have to call Humana to search a deposit.

We are also registered with Change Healthcare (https://dental.changehealthcare.com) provider website.  I can get EOBs, ERA/EFT search results at this one site for all of my Guardian, AETNA, Cigna, Ameritas, GEHA, FEHBP claims.

We are registered at many individual websites:  AETNA, MetLife, United Concordia, GEHA, etc. but only access them if I need additional EOB or Predetermination information.

Once I developed my daily EFT routine, it doesn't take me long.  What's confusing is that all sites are different.  So, as long as I remember where to look on each site for an EOB/EFT info, I'm in and I'm out. Done!  Don't get distracted by all the other claims listed. Only look for today's EFT checking deposited amounts.

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[djl2502]

I am not sure if this will help but I handle MetLife EFT payments differently.  Fortunately, we have not had any issues at all with MetLife.  We opened a second bank account specifically for EFT deposits.  Once a week, I print a list of claims for the previous week.  For example, today I printed a date range from March 29th-April 4th off of the MetDental website.  It is called 'Claim Summary by Practice.'  I then review the claims and the payments.  Obviously, regular recare appointments which are paid in full do not require review, but any treatment or orthodontic claims I check over to see if benefits were paid appropriately.  If a claim needs follow up, I print the EOB and go from there.  I then post the claims as a Bulk Payment.  Super, duper easy!!    When the bank statement arrives, I compare the statement to the Claims Summary.  I have not had any discrepancies arise.  The funds are always in the bank already!  

This is an option that has worked extremely well for our very busy dental practice.  

[annag]

Our system to track EFT payments involves two Excel spreadsheets:

1. We actually created a separate checking account in our bank SOLELY for EFTs. Our Billing department has access to this bank account and each morning they log into the bank website and download the current days transactions and copy and paste into a spreadsheet. We added a column that simply says "Posted" and mark things off as they have been posted in WinOMS.

2. The Billing Dept. then goes to various websites to locate the electronic remittances to match up with the EFT we have received in the bank. We have tried consolidating onto one website for ERA, but have yet to find one that handles all involved payers efficiently. We copy and paste the list of saved ERAs into a spreadsheet to keep track of which have been saved / worked (mostly for no-pays). We keep track of when last reviewed and search ERAs by date range. 

3. We only post the ERA if we have the EFT in the bank, and reconcile/balance each end of the month to make sure everything was posted.

[kevinlund]

All you have to do is read through this thread to see how great EFT's are! The insurance companies tell us that they will Make Our Lives Easier! and we will Get Paid Faster! Yet, to deal with this great convenience, we have to:

• Open up separate bank accounts
• Create EFT specific spreadsheets
• Download bank transactions daily
• Have bookmarks for every insurance company
• Call the insurance company every time an EFT comes in
• Spend an extra hour reconciling bank statements
• Ignore the ERA and use the Bulk Insurance Check feature
• and etc.

Wow, I can almost taste the productivity! 

[drcavola]

Kevin,  I get the frustration, and I appreciate the sarcasm.  Very nice (not sarcasm).  So, I'll compare your list of "have to's" to our work flow in our office:

• Open up separate bank accounts  ours:  Nope.  Didn't do it, and no worries about an ACH reversal either
• Create EFT specific spreadsheets  ours:  Our financial coordinator does one
• Download bank transactions daily  ours:  Nope.  Just view the credits every banking day
• Have bookmarks for every insurance company  ours:  Yep, right next to the facebook, macy's bookmarks
• Call the insurance company every time an EFT comes in  ours:  Nope, rarely have to call for EFT info
• Spend an extra hour reconciling bank statements  ours:  that's the job for our accountant
• Ignore the ERA and use the Bulk Insurance Check feature  ours:  Give you credit on this one
• and etc.   

[kevinlund]

It's Monday morning, we got two inches of snow yesterday, but I am somehow less sarcastic than last Friday!

Our office is actually in pretty decent shape. We only get a one or two EFT's a month where we have to contact the insurance company, and I've improved my bookkeeping skills to make the reconciliation easier.

It's still more complicated than it needs to be.

[lakegirl]

we recently made the decision to STOP taking EFT ( we only were accepting MET just to see how it went before adding others) because the INS CO and SOFTDENT were  not able to efficiently and programatically handle EFT . As well, the EFT that come to office NEVER aligned with the bank deposits and after a year of too much manpower and time spent on this, we have requested paper checks again. Our first paper checks with matching EOB ( imagine that novelty) arrived yesterday and book keeping is back on track. Once the INS company can figure out a way ( not sure why this is so difficult) to have each EFT match the bank deposits and SOFTDENT gets actively involved in making this easier too we will look at returning ( because certainly the elelctronic deposit of funds is far easier and safer). But for now, we can stop wasting so many hours on this nightmare. And YES MET does allow you to return to paper checks. 

[pksaari79]

Such a good point and I appreciate your information.   This is what I am afraid of so we will NOT be venturing that way anytime soon. Glad it apparently works for some offices but Lake Girl's situation is my worry and biggest nightmare.  Thanks for sharing!!