EOB Posting Process in iClinic

1. Introduction

This guide outlines the step-by-step process for posting Explanation of Benefits (EOB) in the account section of iClinic. The instructions cover searching for accounts, posting insurance payments, handling secondary claims, and managing patient balances.

2. Accessing the Account Section

1. Log In: Sign in to your iClinic account.
2. Navigate to Account Section: Locate and click on the Account Icon from the dashboard.
3. Search for Accounts: 
   • Use the Search by Billing ID field at the top-left corner.
   • Enter the Billing ID and click Refresh to locate the corresponding account.

3. Posting Insurance Payments

1. Open the Account: Click on the Billing ID (in blue) to access the account details.
2. Edit EOB Information: 
   • Click Edit next to the EOB section.
   • Fields under Allowed, Paid, Deductible, Co-insurance, Co-payment, Other will become editable.
   • Enter the relevant amounts from the insurance EOB.
   • Click Save when done.
3. Enter New Insurance Payment: 
   • Click New Payment next to the Insurance Payment section.
   • In the Insurance Payment Editor, enter: 
     • Pay Date: Select using the calendar or type the date.
     • Check Number and Check Amount.
     • Paid Amount for this specific account.
   • Click Save to confirm.
4. Mark Account as Paid: 
   • Select Paid under Account Status/Sub-status.
   • Click Save.

4. Handling Secondary Insurance Claims

1. Verify Secondary Insurance: 
   • Check the patient demographics to confirm secondary insurance details.
2. Prepare for Secondary Claim Submission: 
   • Ensure the primary account is marked Paid.
   • Verify there is an insurance balance reflecting in Co-pay, Co-insurance, or Deductible.
3. Submit to Next Insurance: 
   • Click Next Insurance.
   • Confirm the prompt to create a secondary claim.
4. Process Secondary Claim: 
   • Go to Billing List.
   • Search for claims in New Status with an Orange #2 indicator.
   • Open the claim, click Validate, and then Send if the information passes validation.
5. Post Secondary Insurance Payment: 
   • Access the secondary account under the primary account.
   • Repeat the steps for Editing EOB Information, Entering New Payment, and Marking as Paid.

5. Managing Patient Balances

1. Identify Patient Responsibility: 
   • Move unpaid amounts to the Patient Balance column using: 
     • Green Arrows between insurance and patient columns, or
     • Move All Balance to Insurance Adjustment/Patient Write-off button.
2. Generate Patient Statement: 
   • Click Bill Patient Letter.
   • Choose the appropriate letter (Primary, Secondary, Tertiary, or Self-pay).
   • Print the letter from the new window.
3. Apply Patient Payments: 
   • Click New Payment next to Patient Payment.
   • Enter: 
     • Pay Date, Payment To, Office Location, Payment Amount, Payment Method, and Reference Number.
     • Add internal notes if needed.
   • Click Save and Print to save and generate a receipt.
4. Apply Payment to Account: 
   • Click Apply.
   • Enter the payment amount under the corresponding section (e.g., Co-payment).
   • Click Save.
5. Handling Write-offs: 
   • If no payment is made, transfer the balance to the Write-off Column.
   • Add notes explaining the reason for the write-off.
   • Click Save to finalize.

6. Correspondence and Reporting

1. Access Correspondence Section: 
   • Review templates for Outstanding Balances, Missed Appointments, Overpayments, Bad Debt, and more.
2. Generate Letters as Needed: 
   • Select the appropriate letter based on the account status.
   • Print and send as required.

7. Best Practices

• Regular Validation: Always validate claims before submission to secondary insurance.
• Accurate Data Entry: Double-check EOB details when posting payments.
• Clear Documentation: Use internal notes to document payment decisions and write-offs.

8. Troubleshooting Tips

• Account Not Found: Verify the Billing ID is correct and click Refresh.
• Claim Not Validating: Check for missing demographic or insurance information.
• Payment Discrepancies: Ensure amounts match the EOB before saving.

9. Support Resources

• In-App Help: Use iClinic’s help feature for guidance.
• Technical Support: Contact the support team for system-related issues.
• Billing Department: Collaborate with billing specialists for complex cases.

This guide ensures efficient and accurate EOB posting, secondary claim processing, and patient balance management within iClinic.