Processing Payments

DrCloudEHR provides full support for processing and reconciling payments sent electronically through a claims clearinghouse, or received manually from insurance payers and patients.

This topic contains the following sections:

Processing Electronic Payments

When an insurance payer sends you payment for a claim submitted electronically, the insurance payers generates an electronic remittance advice (ERA) file containing details on payments and adjustments. DrCloudEHR scans the file and posts the payment and adjustment details to the DrCloudEHR payment system.

Automatically Process Electronic Payments

If an insurance payer processes claims through a clearinghouse, the company sends ERA files to the clearinghouse. DrCloudEHR downloads the ERA files from the clearinghouse on a scheduled basis. The application scans each file and automatically posts the payment and adjustment details to the DrCloudEHR payment system. No additional action is required on your part.

You must configure connections to the clearinghouse to automatically download ERA files. For more information, see Enable Electronic Payment Notifications.

Manually Process Electronic Payments

If an insurance payer does not send ERA files through a clearinghouse, you might need to download the files directly from the insurance company. You can then manually upload the files from a local directory on your computer to DrCloudEHR. 

Due to the amount of data being processed, the ERA process runs in the background, so that you can continue to use DrCloudEHR while the process runs. The application sends you an email when the process completes, and generates pa report in .html format that provides details on the results.

Note: You must configure your web browser to allow popup windows to post and process ERA files.

1. Click the Billing  tab.
2. Click Payments in the left-hand navigation menu.

3. Click the ERA Posting tab in the Payments/Refunds page.

4. Start typing the name of the insurance company, and then select the company.
5. Click Choose File to upload the ERA file.
6. Click Process ERA. A pop up window listing the check numbers in the file displays.
7. Select the checkbox for each check you want to include.
8. Click Process. The ERA process runs in the background. 
9. Click Offline Processed ERAs or Offline Reports to view the processing status.
   When the process completes, click the icon under Download/View to download a .zip file containing the report in .html format.

View ERA Processing Reports

You can view reports that contain the details of ERA files processed by DrCloudEHR. You might want to view the report for a claim submitted for an encounter that the application is unable to reconcile.

1. Enter search criteria.
2. Click Search. The details for processed ERA files loads in the table below.
3. Click the plus symbol icon next to an ERA entry in the table to view a summary of the ERA data.
4. Click the arrow icon in the ERA File column to download the original electronic data interchange file generated by the clearinghouse in .edi format. 
5. Click the icon in the Results column to load the contents of the electronic data interchange file in the window.
   The results provide you with options for investigating issues in the payment, as well as methods for notifying others if any actions are needed.
   • Click the View Encounter Forms icon in the Invoice column to view the details for the encounter the payment is for.
   • Click the Adjustments icon to view claim details in the Statement Manager, including any adjustments made.
     You can update the claim details with any payments made and reconcile the claim.
   • If the provider needs to address the issue, click the Send Message icon to send the provider an email.
   • To assign a task to the provider, click the Send Reminder icon.

Processing Manual Payments

You can manually process payments received from insurance payers and patients. When you process a payment, you specify the amount to allocate for each service provided.

Process Payments from an Insurance Company

If you do not file a claim with an insurance payer electronically, the payer sends you an explanation of benefits (EOB) form containing payment details for services provided. The EOB form might contain data for a single patient, or more typically will include data for multiple patients. For each patient for which payments are described in the EOB, you allocate the payment amounts for each service code listed.

1. Click the Billing  tab.
2. Click Payments in the left-hand navigation menu.
3. Click New Payment.
4. Enter the payment details.
   • Select Insurance Funding Source from the Paying Entity menu.
   • Start typing the name of the insurance payer in the Payment From field, and then select the payer from the popup list.
5. Click Save and Allocate.
6. Start typing the name of the patient for which you want to allocate payments in the Patient field, and then select the patient from the popup list. 
7. For each service code shown, select the insurance payer in the Post For column:
   • Ins1: Primary Insurance
   • Ins2: Secondary insurance
   • Ins3: Tertiary insurance
8. Enter the payment and adjustment details for the service.
9. Click Post Payments when you have allocated payments for all of the services listed for the patient.
10. If multiple patients are included in the EOB, click Save and Allocate again, and repeat the process for the next patient.

Process Payments from a Patient

If a patient provides payment for services, you can automatically allocate the payment amount for each service provided. DrCloudEHR allocates payment amounts based on the most recent services rendered, and automatically posts the payments.

1. Click the Billing tab.
2. Click Payments in the left-hand navigation menu.
3. Click New Payment.
4. Enter the payment details. Select one of the following options from the Paying Entity menu:
   • Patient: Select for a full payment from the patient.
   • Capitation: Select for a payment that makes up the difference between what insurance pays per a capitated contract, and the total amount due.
   • CoPay: Select for a payment that is the patient's portion of the charge for a covered service.
5. Click Save & Auto Allocate.