Steps to review a Payment´s Claim Status Analysis:

01 - Review priority claims which Follow Up Date is expired because we have a timeframe to achieve the payment.
> Task asssigned to you, usually take this date into account.

02 - Review the Claim info is well: if the Rendering Provider, Billing Provider, Facility and Primary Insurance.
> You can guide by adress or if you have doubts go to Practice Fusion.

03 - Review the Claim Status in Charge Section of the Claim to understand quickly what happen with the claim:
> Claim at Insurance.
> Balance due Patient.
> Rejected or Denied.
> Paid and what is the level of the Payment versus Amount:
> Paid in US$0.
> Paid w. = < 40% of Amount.
> Paid w. > 40% and =< 80% of Amount.
> Paid w. > 80% of Amount.

% Payment Calculator:

Insurance Paym.:
Patient Paym.:
Total Paym.: $0.00
Amount: $150.00
% Paym.of Amount: 0.0%

04 - Read the payment status in Claim Summary Section and quickly you can classify this in one of four cases archetypes
to follow the steps to solve it:
Ins. Paym. Pt. Paym. Total Paym. Adjustm. Balance Gen. Action
Case 01 - No Pt. Paym. Yes No Only by Ins. Yes No 6.1
Case 02 - Balance Yes No Both Pays Could be Yes 6.2
Case 03 - At Ins. No Yes Both Pays Could be No 6.1
Caso 04 - Wh. Apply No No Both Pays No No 6.1 & 6.2

05 - Search the Remmittance from Insurance to apply it and the Pt. Payments if it has and apply it too.
> If Remmittance comes with a Payment in US$0 or =< 40% and Pt. Payment doesn´t cover > 40% of the
claim please continue with the step 06.1.
> Review the step 06.2 to follow up the steps to documented correctly the Pt. Payment in each claim.

06 - If Remmittance doesn´t find or comes with a Payment =< 40% is necessary review what happen with the Ins. Payment;
also if this claim has a Pt. Payment:

06.1 - In case of the Insurance´s Payment =< 40% and Pt. Payment doesn´t complete the Payment´s claim then:
> Review Track Claim History and look for an unpaid reasons or explanations to indicate us what the problem with the
Payment´s claim is.
> You can investigate more deeply in the Payers Reports come from Clearinghouse or Insurance, download it from the line of
TCH that shows you the unpaid reason (or Claim Tracker).
> If the TCH and Payer Reports isn´t clear you must Call to the Insurance to understand well how to solve the payment.

05.2 - In case that must have an Patient´s Payment that covers partially or totally the Payment´s claim > 40% then:
> Search the document that support the Payment, could be an Invoice in Square or a
> Download the Pt. Payment Document and rename with this nomenclature:
Pt.Full Name (Last Name) Doc.Type - dd Mmm. AAAA (DOS).pdf
> Example: Bellano Thoma Invoice - 03 Aug. 2023.pdf, when 03 Aug. 2023 is the DOS, it doesn´t matter if the Pt. Pays
before DOS.
> Apply the Pt. Payment in the CMD Section of the claim for this task and save it.
> Upload the Document Support in the CM Document Section.

06 - After apply Ins. And Pt. Payments available, review again the % of Claim Payment vs Amount and classify in:
> Paid in US$0.
> Paid w. = < 40% of Amount.
> Paid w. > 40% and =< 80% of Amount.
> Paid w. > 80% of Amount.

% Payment Calculator:

Insurance Paym.:
Patient Paym.:
Total Paym.: $0.00
Amount: $150.00
% Paym.of Amount: 0.0%

> Go to the next step to complement Follow Up Notes.

07 - Fill in Follow Up Notes according this instructions:

> Use the Standart Follow Up Note according each case, and adjust it with the information that you get in the investigation
process.

07.1 - If the Payment´s Claim is in US$0 or is Paid w. = < 40% of Amount:

> Copy the Unpaid Reasons founded in TCH that helps us to uderstand how to solve the Payment´s claim.
> Read and analyze the Payer Report and add the key information about Unpaid Reasons or Causes of unpaid or
low Payments.
> Add the info. given by Insurance in the Calls that you have to do, writing it in Follow Up Notes.
> Also write the issues founded in the Pt. Payments.
> Now you are ready to solve the claim with a task at your own or for another member team. Go to the step 08.

07.2 - If the Payment´s Claim is Paid w. > 40% and =< 80% of Amount.
> Copy the Unpaid Reasons founded in TCH that helps us to uderstand how to improve the Payment´s claim.
> Now you can close the Payment´s Claim in the Follow Up Notes with:
> Paid w. > 40% and =< 80% of Amount.
> Don´t forget share with the team lessons learned about how to improve the payment´s claim or the restrictions
and limits of allowable amount of Insurances.
> Also write the importante facts founded in the Pt. Payments.
> Now you are ready to close the task of this claim. Go to the step 08.

07.3 - If the Payment´s Claim is Paid w. > 80% of Amount.

> You don´t need to copy anything from TCH.
> Now you can close the Payment´s Claim in the Follow Up Notes with:
> Paid w. > 80% of Amount.
> Now you are ready to close the task of this claim. Go to the step 08.

08 - Manage the Task Module according this instructions:

> Create or Update a Task depending of the case from an Standart Task and make the ajusments particularly.
> You can assign a Task for yourself or for someone more in the team.
> Update the Claim Status depending of the advance of the Tasks inside it:
> If the Task is assigned to somebody and none of the point inside in it have begun let the global
Task Status: Not Started.
> If your Task have several points and some of them can not be solve put Pending next to the points and
let the global Task Status: In Progress.
> If your Task depends of another Task that must be done for someone else, let the global Task Status: On Hold.
> If all the points inside in your Task were solve including the Task must be done for others to close you Task, let the
global Task Status: Complete.

> You can find or copy this Standard Task, and you are going to modifiying depends that you need and do.