The Pending Patient buckets in the Claims tab are reserved for claims that have been returned from the payer(s), and still have a remaining balance. i.e., if the total charge on a claim is $100 and the insurance paid $80, the claim would end up in Pending Patient to reflect that the remaining $20 still needs to be paid.
Please note that claims that have received denials or rejections from the payer will end up in the appropriate Needs Attention bucket.
There are three tabs within the Pending Patient bucket: PR Mismatch, Charge, and Collect
- PR Mismatch
- Claims end up here when there is a remaining balance on a claim that hasn’t been properly accounted for after adjudication. In other words, the system is unable to categorize the balance—it has not been adjusted off, nor has it been assigned as the patient’s responsibility
- More information on this tab is available here: PR-Mismatch
- Charge
- Claims end up here when there is a remaining balance on the claim that has been designated as patient responsibility, but the balance has not yet been charged to the patient. You can think of this bucket as advising you to Charge these balances to the patient
- Collect
- Claims end up here when the remaining balance has been charged to the patient. Any remaining balances here will reflect in the patient's chart under Charges, associated with the appropriate date of service
Claims end up in the Charge tab when there is a remaining PR amount on the claim that has not yet been added as a charge to the patient's account. You can work these claims in one of two ways: write off the remaining amount or bill to patient.
To write off the remaining balance, please follow these steps:
- Select the claims you would like to charge to write off by checking the box to the left of the DOS
- Click Actions in the top right corner
- Select Write Off Claims
- Add Adjustment Type and Reason Code as desired
- Enter Total Amount to Remain
- The amount entered here will be the desired remaining balance to keep open on the claims after the write-off
- More information on this write-off process is available here: Bulk-Write-off
To charge the remaining balance on the claim to the patient, you will want to move claims from the Charge tab to the Collect tab - this will reflect that the remaining balances are now charges in the patient's chart. You can move these claims from the Charge tab to the Collect tab by following these steps:
- Select the claims you would like to charge to the patient by checking the box to the left of the DOS
- Click Update Charges in the top right corner
Once these charges are updated, they should move to the Collect tab and populate in the patients' charts as outstanding charges.