This can occur if there are insurable transactions in the patient transaction history that were never submitted to insurance OR if insurance checks were posted without being tied to a claim. This issue can also occur if an outstanding claim has been deleted or cancelled before it was paid.
Checking for Outstanding Claims
1. Open the patient's or account's transactions.
2. Click Outstanding Insurance button to display the outstanding claims. Note any outstanding claim numbers.
3. Go back in to the patient's or account's transactions and click [Claim Status].
4. Search the transaction ledger for any of the three claim status types:
5. If claims exist within the outstanding claims continue to the following section.
6. If claims do not exist within the outstanding claims but claim statuses "PR or SC" are visible then follow the steps outlined in the last section.
1. While in the patient's or account's transactions click Payments in the Express Bar OR press <Y> to display the payment screen.
2. Put a check in the Insurance option. The Insurance Payment window is displayed.
3. Enter the desired insurance check payment code in the "Code:" field. If it is necessary to decline the payment, it may be necessary to create a "Declined Payment" or a "Finalizing Payment" transaction code with the 2.01 - 2.89 range.
4. Enter the amount of the insurance check payment. If the payment is being declined then merely enter a $0.00 payment.
5. Select the appropriate claim number to which the payment is to be applied. Please note that when posting an insurance check to a patient, it is important to select the claim # for which the payment is for from the field labeled "Claim #" in the insurance check payment window.
6. Should the payment being entered NOT be the final payment, deselect the Final check box.
7. Click Post to complete the payment.
Removing Unlinked Claims (PR or SC with no Claim)
If the claim status "PR or SC" is still visible within the patient's transactions and no outstanding claims are visible within the [Outstanding Insurance] window, it will be necessary to remove the insurable checkmark in the transaction in order to remove the incorrect balance. To remove the insurable flag from the associated transaction:
1. Within the patient or account's transactions, double-click on the transaction with the incorrect balance.
2. Take the check mark out of the box labeled "Insurable" and click OK to close the transaction. The insurance balance for that transaction will be removed from the patient.
3. If it is necessary to resubmit the claim, merely edit the transaction and re-check "Insurable" and then click OK. Submit the claim as normal.
**Also check to see if an item was marked as "Insurable", within the transactions list, that should not have been. Unchecking that item that was marked as "Insurable", will decrease that insurance amount. **