Payment Posting Remit Detail Tab

Remit Detail

The Remit Detail tab is used to manage remit detail for an insurance payment. This child tab is only available if an insurance batch and payment has been selected from the work queue.

Insurance payment information along with claim denials and service line detail can be added or updated for the payment line item. This information may also be imported from an 835 ERA import file.

To add/update remit detail, follow these steps:

1. Control No – Enter the control number provided by the payer.
2. DRG Id – Enter a DRG code in the first field or a DRG description in the autocomplete field (clicking a suggested description to select it).
3. Deductible – Enter the dollar amount for the patient’s deductible.
4. DRG Paid Amt – Enter the amount in dollars paid based on the DRG.
5. Co-Insurance – Enter the dollar amount for the co-payment.
6. Covered Days – Enter the number of days covered by the insurance.
7. Non Covered Days – Enter the number of days not covered by the insurance.
8. Non Covered Amt – Enter the non-covered amount in dollars.
9. D/S Amt – Enter the Disproportionate Share amount in dollars.
10. DSH Amt – Enter the Medicare PPS Disproportionate Share amount in dollars. This is a special adjustment for hospitals serving a “disproportionate share” of indigent patients.
11. IME Amt – Enter the Medicare PPS Indirect Medical Education amount in dollars. This is a special adjustment to cover teaching costs for residents and interns.
12. Reimb Rate % – Enter the Medicare PPS reimbursement rate percentage as a decimal.
13. Outlier Amt – Enter the Medicare PPS Outlier payment amount in dollars. This is a calculated amount for a case that has incurred extraordinarily high costs.
14. Capital Amt – Enter the Medicare PPS Capital amount in dollars. This is a calculated amount based on each provider’s incurred or “reasonable” cost for capital items (building, equipment, etc.).

15. Click Save.

Claim Denials

The Claim Denials tab is used to manage claim denial information on an insurance payment. This child tab is only available if an insurance batch and payment has been selected from the work queue.

CAS (Claim Adjustment Reason) reason codes explain why a claim or service line was paid differently thant it was billed. Remittance advice remark codes provide additional information on the denial or regarding remittance processing. Denial codes and remarks can be entered manually or imported with an ERA 835 file. Remarks are noted by an asterisk in the Rmk column.

To add a claim denial/remark, follow these steps:

1. Click the Add button . A row is added to the list and and the fields are enabled.

2. Remark – Check to classify the denial as a remark.
3. Vendor Group ID – Click the dropdown and select the vendor group. The group may have its own set of CAS reason codes (other than the standard federal codes) and ERA processing rules.
4. Code – Enter a CAS reason code in the first field or a CAS reason description in the autocomplete field (clicking a suggested description to select it). The reason code’s type displays.
5. Quantity – Enter the quantity of denials.
6. Amount – Enter the amount in dollars of the claim denial.
7. CAS Group Code – Enter the CAS Group code. The group code used to identify who is financially responsible for the amount that the payer is not reimbursing.
8. Click Save.

Update Denial/Remark

To update a denial/remark, follow these steps:

1. Click on a denial/remark in the list to select it.

2. Update any information.
3. Click Save.

Delete Denial/Remark

To delete a denial/remark, follow these steps:

1. Click on a denial/remark in the list to select it.

2. Click the Delete button . The denial/remark is deleted from the list.
3. Click Save.