Payment Applications

The final step in the billing process will ensure the payment is applied to the consumer/unpaid claim in the system. 

After you download/process 835 files and post cash receipts, the system will automatically apply payments to open claims.  If a payment does not automatically clear, you will need to manually link the 835 payment to the service.

 You must download 835 files, process 835 files, and post cash receipts for the system to begin automatically clearing payments.

Payment Applications

The system automatically matches payments to claims based on the recipient number, date of service, procedure code, and rate. If the system is unable to automatically match claims, the payment will display on the Payment Application screen. You can manually link the payment to the claims.

NAVIGATION: RECEIPTS/835 menu > Payment Applications

  1. In the PAYOR SELECTION field, select PROMISe.
  2. The PAYMENT SELECTION section will display any payment that did not automatically find an exact match for all claims covered by the payment.  
    1. Ideally, this screen should always be blank if the system was able to automatically match all submitted claims to the claims paid/listed in the 835 file.
    2. Claims submitted manually in PROMISe will appear in the section and you will manually clear the payment (see below)
    3. Adjustments will appear in the section and you will manually clear the payment (see below)

Research Payment Information

  1. If you click on the DOCUMENT link, the 835 Console will appear.
    1. The console shows you the detailed payment information from the 835 file in the CHECK INFORMATION section.
  2. In the CHECK DETAILS section, you will see the claims that were not automatically matched to an open claim in the system.
    1. Review the code, service date, error, etc., to try and determine which open claim the payment should be applied to.
  3. On the right side of the screen in the REPORTS section, you can click on the link to view a Payment Application Detail Report or Payment Application Error Report for the specific time frame you are processing.
    1. Click the CLOSE SCREEN icon to return to the previous screen.
  4. Once you have gathered the details you need to match the payment to the open claim, click CLOSE at the top of the screen to close the 835 console and return to the Payment Applications screen.

Manually Clear the Payment - Payment Applications

After you have determined the consumer that the open claims should be applied to, you will need to manually complete the payment application process. 

NAVIGATION: RECEIPTS/835 menu > Payment Applications

  1. In the PAYOR SELECTION field, select PROMISe.
  2. In the SUBACCOUNT field, select the consumer that the payment needs applied to.
    1. If you do not select a consumer, all open claims in the system will appear.
  3. In PAYMENT SELECTION, place a check box in the SELECT column for the payment you are attempting to clear.
    1. When you select the document, you will notice an Amount to Apply to the left. This is the remaining amount that did not automatically apply.
      1. For example, if the check was for $17,115 but only $1,367 could not be automatically linked to the open claims, the $1,367 amount will display in the AMOUNT TO APPLY field.
  4. On the right side of the screen, click the DISPLAY INVOICES icon.
  5. The grid will populate with any open claims for the consumer you selected in the previous step.
    1. You can click on the column headings (paid, amount paid, etc.) to sort the data in the grid.
  6. Find the claim that the payment covers. Place a check mark in the first column named PAID.
  7. As you check the claims to apply to the payment, the AMOUNT APPLIED field will total the claims you checked.
  8. Before proceeding, make sure the Amount to Apply and Amount Applied should equal.
    1. If the payment is for multiple consumers, these amounts will not match.
  9. Click the PROCESS icon so that all the claims you have checked will be marked as paid and moved to history.
  10. To review the application report, click the REPORT icon.

Claims Submitted Manually in PROMISe

Claims submitted manually in PROMISe will appear in the Payment Application section and you will manually clear the payment.

  1. Research payment information to find the consumer the payment should be applied to.
  2. Enter and post an adjustment for the payment.
    1. The adjustment can be entered for one consumer or for multiple consumers using the 00 - No Consumer subaccount.
  3. Manually clear the payment on the Payment Application screen.

PROMISe Adjustments

PROMISe adjustments are included in 835 files and need manually cleared.  

  1. Research payment information to find the consumer the payment should be applied to.
  2. Enter and post an adjustment for the payment.
    1. The adjustment can be entered for one consumer or for multiple consumers using the 00 - No Consumer subaccount.
  3. Manually clear the payment on the Payment Application screen.

VIDEO: PAYMENT APPLICATIONS

SEE ALSO: Process Adjustments and Reprocess 835 Payment Application Errors

6/2023

NEED MORE HELP?  Submit a ticket to the Help Desk or call (814) 535-7810 or (800) 889-3388