NPAWorks Billing

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Contents

Enabling the Billing feature

Clearinghouse Onboarding.

Master Funding Source

Claims Wizard

Adding Billing Organization and Provider Taxonomy codes

Confirming appointments are ready for billing

Generating Claims with Claims Wizard

Submitting Electronic Claims with Claims Wizard.

Claims Manager

Viewing Claim Statuses

Accepted Electronic Claims

Rejected Electronic Claims

Claims Ledger

Claims Ledger tab

Viewing Charge Lines

Charge Lines – Transfer Balance and Post Adjustments

Access Edit Charge Line page

Charge Line Actions

Bulk Update Charge Lines

Edit Charge Line Actions

View Payment Details from Transaction History

Client Statements

View & Download Client Statements

Post Transferred Responsibility

Generate Client Statements

Invoices

Generate Invoices

Submitting and Saving Invoices

Releasing Invoices

Posting Actions to Invoices

Payments

Auto-Posted Claim ERA Payments

Unmatched ERA Payments

Add Payment for EOB, Client Statement or Prepayment, or Invoice

Apply EOB Payments

Apply Client Statement Payments

Apply Regional Center, School District, and Private Pay payments

Import CA Regional Center Payments

Payments Ledger

Billing Reports

Using Billing

 

Enabling the Billing feature

Clearinghouse Onboarding

Contact Support at 877-796-9883 or support@codemetro.com to enable the Billing feature.  The ability to generate and post payments to non-insurance funding sources can be enabled immediately and training, if desired, scheduled.

If you also bill private insurance, you need to select a clearinghouse, Apex or Office Ally.  Apex is recommended because of cost effective transaction rates and a dedicated Account Manager to assist you with the integration set-up, enrollments and on-going support.  NPAWorks also integrates with Office Ally.  You will need to work directly with Office Ally to request integration and submit payer enrollments.  When contacting CodeMetro Support to enable the billing feature please request instructions for Office Ally integration steps.

Master Funding Source

  • Initial set up for the Master Funding Source: Master Funding Source is found in the Settings tab and is needed to post and apply payments. The Master Funding Source contains all the unique funding sources a practice contracts with across all the practice’s agencies. When the Billing feature is enabled, NPAWorks will automatically generate a Master Funding Source record for each unique funding source. Each master record is mapped to its corresponding agency funding source record.

During initial set up for insurance funding sources, the system will:

  • Default the Network field to Commercial.
  • Where possible, take the payer ID from the agency’s funding source record and assign it to either the mapped master record’s Office Ally payer ID and/or payer ID, and depending on which clearinghouse will be used. If the practice is in the process of migrating from Office Ally to Apex, both clearinghouses’ payer IDs will be displayed, otherwise only the ID for the clearinghouse used is displayed.
  • It may not be possible for NPAWorks to assign every insurance payer ID, in which case, the field will be left blank.

PLEASE NOTE: It is important for the practice to review all Master Funding Source records to ensure the mappings and payer IDs are correct, and to update the Network field to Medicaid where needed.

Once the Billing feature is enabled, any new funding sources must be added in the Master Funding Source first, then created in any agency that will use that funding source.  Any updates to a payer ID will be maintained in the master funding source record, and is displayed with view-only on the mapped funding source record.


Claims Wizard

Adding Billing Organization and Provider Taxonomy codes

Claims Wizard will automatically assign billing organization and provider taxonomy codes when claims are generated and sent/exported as with the 837P file format.

To set the billing organization’s taxonomy code, from the Settings tab open the Organization page.  Click on the Special Identifier’s icon.  On the Special Identifiers page click the + icon to add a new type of identifier.  Select type of Taxonomy Code and then enter the code in the ID / Number / Code field.  Click OK to close the page and click Save & Close on the staff record to save the updates.

To set the provider’s taxonomy code, open the staff records and click on the Special Identifier’s icon.  On the Special Identifiers page click the + icon to add a new type of identifier.  Select type of Taxonomy Code and then enter the code in the ID / Number / Code field.  Click OK to close the page and click Save & Close on the Organization page to save the updates.

Confirming appointments are ready for billing

It is recommended to run the Insurance Appointments Check flex report before generating claims to verify that appointments are ready for billing.  Information included in the report include

  • Is appointment rendered?
  • Is there a diagnosis code?
  • Is there a service location?
  • Is the appointment overlapping with another service appointment?

Generating Claims with Claims Wizard

To generate insurance claims, select the Billing tab and click on Claims Wizard in the ribbon.

Alternatively, from the Claims Manage, click on Claims Wizard in the upper left corner.

Step 1 of Claims Wizard is displayed. Select filters and click Search.

Use checkboxes to select the appointments to be included and click Next.

Step 2 of Claims Wizard is displayed.  Any appointments missing required claim data such as CPT Codes, Diagnosis Code, and Rendering Provider are noted in the Errors column.  Click on an appointment with Errors noted and Error Types are displayed in the bottom panel.  It is recommended to correct missing data at the source (e.g., enter the missing Rendering Provider on the Client Services record) and then return to Claims Wizard to generate claims.  Alternatively, it is possible, however, to enter missing data directly in Claims Wizard, click the Save icon, and continue with claims generation.

The checkboxes in Appointment to Claim Line Item Grouping control how appointments are combined into one claim charge line.  In the example below any appointments with the same Service Date, Place of Service, CPT Code, Modifier, Diagnosis Code, Rendering Provider NPA, and Contract will be collapsed into one charge line.  If Service Date were unchecked, after clicking Regroup, appointments with different Service Dates would be collapsed into one charge line.  Typically all options should be checked unless the carrier has special claim charge line requirements.

Click Next to proceed to Step 3 of Claims Wizard.  If uncorrected errors exist, the user will be warned before proceeding to Step 3.

Step 3 of Claims Wizard is displayed.

As with Step 2, it is possible to correct errors directly on this page.  Click the Save icon after making corrections.

Claim Line Item to Claim Grouping checkboxes determine which data will generate a separate claim.  In the example below a separate claim will be generated for unique client contracts. A single claim can have charge lines with different Service Dates, Places of Service, and CPT Codes up to the 6 claim charge line limit.  Click Regroup after checking or unchecking any option.

Click Prepare Claims to generate the claims for selected rows.

Submitting Electronic Claims with Claims Wizard

After clicking Prepare Claims the claims just generated are displayed in Claims Manager.  Select the claims to be submitted and then click on submission options.

If the NPAWorks Billing feature is enabled, depending on the practice’s selected clearinghouse, the submission options dropdown in Claims Manager allows an option for “Send 837P (Office Ally)” or “Send 837P (Apex)”. Both options may be displayed if the practice is in the process of migrating from one clearinghouse to another.  If the practice is using Kareo for billing, then the “Send to Kareo” option is allowed.  Likewise, if the practice is migrating from Kareo to NPAWorks Billing, both Kareo and a clearinghouse option are allowed.

If the NPAWorks Billing feature is not enabled for a practice, the allowed options in Export Claims dropdown are “Export 837P (Office Ally)” and “Send to Kareo” if the practice uses Kareo for billing.

Select a submission option.

When “Send 837P (Office Ally)” or “Send 837P (Apex)” is selected the Submission Date, Submission Type are automatically updated.  The Status is set to Submitted pending confirmation of acceptance or rejection from the clearinghouse.

NPAWorks will detect if the same claim has been previously submitted to avoid duplicate claim submittals.  Clearinghouses can take up to 24 hours to send back to NPAWorks an acceptance or rejection notice.  If the prior submittal was within the last 24 hours, NPAWorks Billing will not allow a resubmission.  After 24 hours, the user is warned but can proceed with a resubmittal.

Please note when NPAWorks Billing is enabled the bulk update options are no longer available for Submission Date, Submission Type, Status, and Notes as these fields are now updated by the system automatically.

Claims Manager

Viewing Claim Statuses

Status of claims can be seen in the Claims tab of Claims Manager.  When a claim is generated and sent electronically to a clearinghouse the claim status of Submitted is initially assigned.

When Claim is printed and mailed/faxed to the payer rather than sending to a clearinghouse, the user should select Submission Type of Print.  The claim status is automatically to Submitted and will remain with that status until a payment is manually applied in the Payment Ledger, at which time the status will automatically update to Manual Posting.

Accepted Electronic Claims

Every 30 minutes after submittal, NPAWorks Billing checks for updates from the clearinghouse regarding whether the claim was accepted or rejected.  When a clearinghouse accepts a claim, it forwards the claim next to the payer’s EDI.  The claim status in Claims Manager changes to Accepted by Clearinghouse, or, infrequently, to Accepted with errors by Clearinghouse when notification of the clearinghouse status is received by NPAWorks.

Once accepted by the payer EDI, the claim is submitted to the payer for adjudication.  When NPAWorks receives the notification that the claim has passed EDI validations the claim status changes to Initially Accepted by Payer EDI.

When NPAWorks is notified that the claim has been adjudicated, an electronic remittance advice (ERA) is posted in the system for any charge lines paid, and the claim status changes to 835 Response.

Rejected Electronic Claims

If the claim does not pass clearinghouse validations the status is changed to Rejected by Clearinghouse.  Likewise, if the Payer EDI rejects the claim the status changes to Rejected by Payer EDI.

When rejected, the user selects the claim, opens the Claims Ledger tab (See Claims Manager – Viewing Electronic Charge Lines) and clicks the link in the Details field to see the reasons for the rejection.

The user will need to correct the missing or incorrect claim data by:

  • Editing the claim, or
  • Releasing the claim, correcting the source data, and regenerating the claim.

Once the errors are corrected, the claim can be submitted again from the Claims Manager Claims tab

Claims Ledger

Claims Ledger tab

From Claims Manager, search for claims and select the Claims Ledger tab. Please note, the Claims Ledger tab displays individual charge lines, while the Claims tab displays claims. Since the Claims Ledger tab contains more columns, it is necessary to page or scroll horizontally to see all columns.

Viewing Charge Lines

When the ERA 835 Response is received NPAWorks Billing automatically posts payments to charge lines and updates Line Status accordingly in the Claims Ledger tab, along with additional information such as payment amount and balances.

Line Status: When auto-posting ERA payments, the amount received is compared to the Expected Reimbursement Amount which uses the practice’s contract rate, as opposed to their fee schedule rates.  (These rates are entered in the Funding Source Services in NPAWorks.)  Line Status is determined as follows:

  • After 835 is received, Claim Status will change to “835 Response” and the Line Status is updated as follows:
    • Short Pay: Carrier payments were less than expected (Expected Reimbursement Amt > sum of all FS payment(s) – Client Responsibility)
    • Overpaid: Carrier payments were more than expected (Expected Reimbursement Amt < All FS payments – Client Responsibility)
    • Client Responsibility: When all Carrier(s) payment(s) are applied and Copay, Coinsurance, Deductible, or Miscellaneous values have been transferred to Client Responsibility
    • Denied: If claim was denied
    • Complete: Paid in full (Expected Reimbursement Amt = sum of all Carrier Payment(s) + all Client Responsibility Payments)

Rejection Reason: a link to Detail will appear when Claim Status is Rejected at Clearinghouse or Rejected at Payer EDI. Clicking the link will bring up a new page which shows the specific reasons why a claim was rejected by the Payer (ex: Incorrect Billing Address).

If the claim was sent to Office Ally, to view the entire history, select the appropriate file under the new “Files” column and select either “Export” or “View”.

  1. HCFA: file from the clearinghouse stating they have the claim and have sent them for processing. The clearinghouse may reject the claim if it has errors.
  2. 5010 (an 835 in readable format): shows payment or denial info after Insurance has received and processed the claim.

Clicking View will display the file in a new page.

Clicking Export will direct the user to select where to save. The file will be saved as a .txt file.

Charge Lines – Transfer Balance and Post Adjustments

Access Edit Charge Line page

Double-click on a charge line in the Claims Ledger to open the Edit Charge Line page.

Transaction History section of the Edit Charge Line page will list all transactions made against the charge line starting with when the claim was submitted, ERAs automatically posted, and the billed Insurance target (Primary, Secondary, or Tertiary).  Any manual adjustments/payments can also be viewed in the Transaction History.

Charge Line Actions

The following charge line actions can be taken:

  • Adjustment – post corrections (e.g., partial balance transfer amount or manually entered copay due entered incorrectly).
  • Transfer Balance – transfer all the charge line balance to another funding source or to client responsibility
  • Transfer Partial Balance to Client Responsibility – transfer a specific amount to client responsibility, typically to bill in advance of the ERA/EOB for copays.
  • Settle – set balance to zero
  • Rebill – used to send corrected claims
  • Note – Add any note related to the charge line
  • Follow-up – Set a date and note for further action needed for the charge line

All actions posted will be recorded in Transaction History along with the date of the transaction and the user.  All action types have an optional note field for comments.

Bulk Update Charge Lines

To apply the same action to multiple charge lines at one time:

  • Select the charge lines to be updated with the checkbox in the Claims Ledger grid
  • Click on Bulk Update Charge Lines
  • Select the action and click Post

Edit Charge Line Actions

Actions can also be applied individually via the Edit Charge Line page.

Action: Insurance Adjustment

The Insurance Adjustment action will display an amount field, and a second dropdown with a list of adjustment codes. Codes are searchable via the keyboard number buttons. Enter an amount, select an adjustment code, enter an options note, and click Post. To enter a negative amount, select the “-“ key on the keyboard.

Action: Transfer Balance

The Transfer Balance action displays dropdown with:

  • The list of Funding Sources per the client contract’s Add’l Funding Sources order of precedence, and
  • Client

When posted the entire charge line balance will be transferred to the funding source selected or to client responsibility.

Action: Transfer Partial Balance to Client Responsibility

 

The Transfer Partial Balance to Client Responsibility displays a dropdown to select the type of Client Responsibility: Copay, Coinsurance, Deductible, or Miscellaneous. Select a type, enter an amount, enter an optional Note, and click Post. The entered amount will be transferred to the selected type of Client Responsibility.

Action: Rebill

When a charge line has been denied by the payer, the user must edit the original claim charge lines in Claims Manager to fix the rejection reason, and then select the Rebill action for one of the denied charge lines.

The Rebill action displays a Note field. Enter a Note, usually the rebill reason, and click Post.

Clicking the Post button will change the Claim Status to Ready for Rebill and the charge Line Status to Pending Insurance for every charge line submitted on the original claim.

When the corrected claim is sent to the clearinghouse from the Claims Manager Claims tab, NPAWorks Billing enters a resubmission code 7 and the original claim number so that the claim does not get denied as a duplicate.

Action: Note

The Note action displays a field for entering comments unrelated to a specific action.

Action: Follow-up

The Follow-up action displays a date when future action is needed and a Note field.  Select a date, enter a Note, and click Post. See Follow-up flex report.

Action: Settle

The Settle action displays a dropdown to select an Adjustment Code, and an optional Note. Select a code, enter an optional Note, and click Post. The Charge Line status is changed to “Completed”, Claim Status is unchanged, and all current balances are set to $0.00.

Action: Discard Claim

The Discard Claim action will remove a claim from the system.  If a denial has been received from the payer, the claim is marked as voided and the void can then be submitted to the payer.  If any payments have been posted to the claim and message that all payments must be reversed before the claim can be discarded is displayed. Once successfully discarded, the appointments linked to the former claim can now be edited.

Action: Client Adjustment

The Client Adjustment action will display an amount field, and a second dropdown with a list of adjustment codes. This action allows for adjustments to copay, co-insurance, or deductible amounts.  To adjust outstanding insurance balances that have been transferred to client responsibility, select the This action will also allow for Misc. Client Discount adjustment code.

View Payment Details from Transaction History

From Edit Charge Line page’s Transaction History it is possible to view payment details.  Select any Payment transaction and select the icon to the left of the date or right click on the transaction. 

When Open payment is selected, the Edit Payment page for the payment for this transaction is opened

When View ERA is selected, the View ERA page with the payment information for this transaction is opened.

The Copy action copies all the selected payment transaction history to the clipboard.  Copy Reference copies only the Ref # for easy pasting in Payment Ledger filters.

Client Statements

View & Download Client Statements

Open the Statements page from the Billing tab.

To view existing client statements, enter filters and click search. 

The Statements page shows the generated statements. Select a statement to see its charge lines.

To delete a statement, select the statement via the checkbox and click Delete. Once a statement is deleted, it cannot be recovered.

To download a statement, select the statements and click Download. Options:

  • Download as a .zip file, or
  • As individual statements within a folder

Statements are generated in PDF format only.

Post Transferred Responsibility

When transitioning to NPAWorks Billing feature from another system, claims generated in the prior system should be closed out in that system.  The Post Transferred Responsibility is used to enter client responsibility balances from the previously used system in NPAWorks so a single statement can be generated for the client. 

From the Statements page, click Post Transferred Responsibility. 

Start typing in the Client filter to search.  Enter the statement billing from and to dates, the amount to be included in the statement, and an optional note.  When the client’s statement is generated, any outstanding transferred responsibility will be displayed as the first line item(s) on the statement. 

Generate Client Statements

Click the Generate New Statements button.

Enter filters and click Search. To include charge lines that are fully paid by the client, uncheck “Show outstanding balances only”.

Select the charge lines for which client statement(s) should be generated.  Click Prepare.

 

Statements are generated by Client for the selected charge lines and the Statements page is opened. Select statements and click Download to view, print, or save.

 

Invoices

Generate Invoices

To generate invoices, select the Billing tab and click on Invoice Manager in the ribbon.

The Invoice Manager page is displayed.  Click on Invoice Wizard in the upper left corner.

Step 1 of Invoice Wizard is displayed. Select filters and click Search.

Use checkboxes to select the appointments to be included and click Next.

 

Step 2 of Invoice Wizard is displayed.  It is recommended to correct missing data at the source (e.g., enter the missing Service Code on the Client Services record) and then return to Invoice Wizard to generate invoices.  Alternatively, it is possible, however, to enter missing data directly in Invoice Wizard, click the Save icon, and continue with invoice generation.

Use checkboxes control what should be generated on a separate invoice.  In the example below a separate invoice will be generated for unique funding source and client. Click Regroup after checking or unchecking any option.

Unit(s) Rounding Rules:

  • Normally – round unit(s) to nearest number of decimals selected
  • Up – always round unit(s) up to number of decimals selected
  • Down – always round unit(s) down to number of decimals selected

The unit size for invoices is always 60 minutes.

Click Prepare Invoices to generate the invoices for selected rows.

 

Submitting and Saving Invoices

Select checkboxes for invoices to be submitted. The line items for the highlighted invoice is displayed in the bottom panel. Each invoices Amount Billed is displayed.  Please note, as payments are applied via the Payment Ledger, the Balance is updated here in the Invoice Manager.

If an invoice has been generated with multiple clients, then the word Multiple is displayed in the Client column for that invoice.

Invoice Manager Options:

  • “Bulk Updates on Selected Invoices” allows the same comment to be added Note field for selected invoices.
  • Click the … to the right of the Print icon to select invoice printing options.
  • Optional feature to change the auto-generated invoice number. Contact support@codemetro.com to enable this feature.

Click Print to create a Word or PDF version of the selected invoices, depending on the preference set on the User Account page. After the submission date is assigned automatically or entered, click Save.  The invoice(s) billing information then will be saved and can be viewed in Invoice Manager and payments can be posted to the Payment Ledger.

Releasing Invoices

If any invoices need to be removed or regenerated, open Invoice Manager, check the invoices to be removed, and click Release Selected Invoice(s) icon. After confirming, the selected invoices will be cleared from the system.  Appointments on the removed invoices will appear again in Invoice Wizard.  Please note that if payments have been posted to an invoice, it will not possible to release the invoice.

Posting Actions to Invoices

To post actions to invoices, double click on a selected invoice.  The Edit Invoice page will open.  Action options are:

  • Adjustment
  • Settle
  • Note
  • Follow-up

 

Payments

Auto-Posted Claim ERA Payments

 

Billing auto-posts ERAs from Private Insurance whether primary, secondary, or tertiary as long as the ERA can be matched to a claim generated in NPAWorks.  See Unmatched ERA Payments for handling ERAs that cannot be matched to a claim.

When an ERA (835) is received and is successfully mapped to a claim, the following are automatically posted to the charge line:

  • Private Insurance payment amount
  • Client Responsibility if present on the ERA, including
    • Client Deductibles
    • Client Coinsurance
    • Client Copay
  • Line Status is determined as follows:
    • Short Pay: Carrier payments were less than expected (Expected Reimbursement Amt > sum of all FS payment(s) – Client Responsibility)
    • Overpaid: Carrier payments were more than expected (Expected Reimbursement Amt < All FS payments – Client Responsibility)
    • Client Responsibility: When all Carrier(s) payment(s) are applied and Copay, Coinsurance, Deductible, or Miscellaneous values have been transferred to Client Responsibility
    • Denied: If claim was denied
    • Complete: Paid in full (Expected Reimbursement Amt = sum of all Carrier Payment(s) + all Client Responsibility Payments)
  • If the client has secondary insurance, any balance that was not paid by the primary is automatically transferred to the secondary. The secondary funding source is set up in the client contract’s Order of Precedence.

Note: It is important not bill secondary until an ERA response from primary is received.

Unmatched ERA Payments

When an ERA is received in NPAWorks that cannot be mapped to an NPAWorks generated claim it will be displayed as Unmatched in the Payment Ledger.  An ERA cannot be auto-mapped and auto-posted if:

  • The claim was generated in another billing software. This will happen when a practice is transitioning from another billing system to the NPAWorks Billing feature.
  • The claim was generated from NPAWorks but not “Sent” to the clearinghouse. This will happen when a claim is printed and mailed/faxed to the carrier, or if the claim was exported from NPAWorks and imported to the clearinghouse portal.

To find unmatched claims, open the Payment Ledger from the Billing tab.

Select Payer Type “Private Insurance” and Payer Name “Unmatched”. Unmatched ERAs, or ERAs that are received off of a paper claim.

Double-click a Reference # to open the Edit Payment page.

Click View ERA.

Click View ERA to review the ERA.  Note the carrier, claim id, and client info. Please note, the View ERA page can be kept open for reference.  Return to the Edit Payments page.

Select the Payer Name on the Edit Payments page.  Click Save.  Click Apply.

Apply payments manually in the same manner as an EOB is posted.  Please see Apply EOB Payments.

Add Payment for EOB, Client Statement or Prepayment, or Invoice

Click Add Payment to manually enter a payment received for an EOB, client statement, client pre-payment, or invoice.

Alternatively, new payments can be added by clicking add payment from the Payment Ledger.

Enter the Payer Type and remaining payment details, any adjustments needed, and click Save or Save and New.  Save will remain on the Add Payment page and enabled the Apply button so payments can be posted to claim charge lines, client statement line items, or invoice line items.  If multiple payments are to be added before applying, click Save & New to enter a new payment.  A payment can be deleted as long as no payments have been applied to it.

Payment Actions

The following payment actions can be taken:

  • Adjustment is used to adjust unapplied balance. For example, an ERA was auto-posted in NPAWorks for a claim that was generated in a different billing software.   Since the claim does not exist in NPAWorks there is no entry to apply payment against.  Use the Adjustment action to set the unapplied amount to $0 with a note explaining the reason for the adjustment
  • Interest – ERA or EOB includes an interest payment from the payer

Once posted, the Payment Summary is updated and the action will appear in the Transaction History page, along with the date of the action and the name of the Staff member who did the action.

Action: Adjustment

The Adjustment action displays an amount field, a list of adjustment codes, and an optional note.  Select an adjustment code and click Post.

Action: Interest

The Interest action displays an amount and dropdown with a list of interest codes. Select an interest code, enter an amount, optional note, and click Post.

Apply EOB Payments

Once a private insurance payment has been saved, the Apply button is enabled.  Click Apply button to post EOB payments to claim charge lines.  Please note: the Apply button is also accessible from the Edit Charge Line page.

Enter filters and click Search.

This page is designed to be able to use with minimal mouse clicks. Take advantage of auto-advance tabbing to tab through the search fields and the Payment Details fields using only the keyboard. After payment details are entered, tab over to the “Save & Next Line” button and select the Enter key on the keyboard to save that payment and advance to the next charge line. When the user has tabbed back to the Client dropdown in the top filters sections, F4 entered on the keyboard opens the Client dropdown to select another client. Tab to advance to the next field.

After all charge line payments have been applied, the system will auto-advance to the next claim. Once all charge line items have been applied for a client, the system auto-advances to the next client.

Please note that this page shares the same Transaction History page for the selected charge line as is displayed in the Edit Charge Line page.

Enter payment details from EOB.  If additional line items are being paid with this EOB, click Post & Next.  Otherwise, click Post.  The Unapplied Amount will be reduced by the payment applied.

The same Actions available on the Edit Charge Line page are available here, with the addition of:

  • Payment Reversal
  • Additional Payment

Action: Payment Reversal

Selecting Action Payment Reversal will allow you to reverse a payment and change the Check Paid Amount. Simply select enter an amount (remember, this payment will automatically be deducted, so do not enter a negative amount) and click Post. The entered amount will then be deducted from the Check Paid Amount.

Once posted, the action will appear in the Transaction History page on the right panel, along with the date of the action and the name of the Staff member who did the action.

Action: Additional Payment

Selecting Action Additional Payment will allow you to post an additional payment and change the Check Paid Amount. Simply select enter an amount and click Post. The entered amount will then be added to the Check Paid Amount.

Once posted, the action will appear in the Transaction History page on the right panel, along with the date of the action and the name of the Staff member who did the action.

Action: Payment Reversal

Select Action Payment Reversal to reverse a payment and correct the Check Paid Amount.  Enter an amount (remember, this payment will automatically be deducted, so do not enter a negative amount) and click Post. The entered amount will then be deducted from the Check Paid Amount.

Once posted, the action will appear in the Transaction History page on the right panel, along with the date of the action and the name of the Staff member who did the action.

Action: Additional Payment

Select Action Additional Payment to post an additional payment and change the Check Paid Amount. Enter an amount and click Post. The entered amount will then be added to the Check Paid Amount.

Once posted, the action will appear in the Transaction History page on the right panel, along with the date of the action and the name of the Staff member who did the action.

Apply Client Statement Payments

Select Payer Type Client and Payer Name.  Enter payment details.  Once a client payment has been saved, the Apply button is enabled.  Click Apply button to post payments to client statements.

When a payment of payer type “Client” has been selected to be applied, the Apply Payments page will automatically change to show Statements instead of claims or invoices. The client name cannot be changed.

Select the first charge line to apply a payment to.  Click Next Line until all the Reference #’s payments have been applied.

Apply Regional Center, School District, and Private Pay payments

Once a regional center, school district, or private pay payment has been saved, the Apply button is enabled.  Click Apply button to post payments to invoices.

When a payment of payer type “Regional Center”, “District”, or “Private Pay” selected, the Apply Payments page displayed invoices for the payer. The regular Apply Payments page functions are available.

Enter filters and click Search.

Enter amount paid in the Payment Details section and click Save & Next.  The invoice payment amount applied is displayed in the Transaction History.  The total amount applied from the Reference # payment is displayed in the upper right section of the Apply Payments page.

Import CA Regional Center Payments

The Billing feature has the option to import payment files exported from the DDS eBilling Portal in CSV format. In order for NPAWorks to properly parse the information in the payment file, be sure to save the file from Excel as a CSV file.

Before importing a payment file, generate invoices in Invoice Wizard.  In Step 2 – Review Invoices always generate separate invoices by Vendor ID and Client.  Be sure to click Regroup when changing invoice generation options.

To upload Regional Center payments, open the Add Payment page.

When a payer type of Regional Center is selected the Import RC Payment icon is enabled. Enter the Payer Name and click on Import RC Payment.

Select the CSV payment file.

The Reference # amount from the import file is updated on the Add Payment page and the Regional Center invoice number(s) are automatically added as a note. Click Save to save the payment and begin the process of applying payments.

After all payments have been applied the Payment Summary is updated and the transaction history are updated. Optionally, the NPAWorks generated invoice number can be updated to reference the Regional Center’s assigned invoice number. Contact support@codemetro.com to enable this option.

Payments Ledger

To access the Payments Ledger, open Billing tab and click on Payments Ledger.

To find an ERAs or manually-enter payment Reference # (e.g., check, credit card payment, EFT), select filters and click Search. Select “Show unapplied only” checkbox to display only Reference #s that have an unapplied balance.

When a Reference # is selected in the top grid, the bottom grid displays the charge lines to which payments have been applied.

Double-click on a Reference # to open the Edit Payment page. If the payment is an auto-posted ERA, Payment Details cannot be changed.

NOTE: it is also possible to navigate to the Edit Charge Line page from the Payment Ledger by double-clicking on a charge line in the bottom grid.

Edit Payments

If the payment was posted manually, the Payment Details can be entered or updated.

Billing Reports

Adjustment Codes: This report shows all adjustments made to charge lines, grouped by Adjustment Code. Adjustment Amount Subtotals are displayed per Adjustment Code. It allows users to see at a glance sum of each adjustment code.

A/R Aging: Aging report that shows outstanding balance by aging buckets as well as unbilled charges for all payer types. Can be grouped by Payers, or by Clients.  This report was formerly called Aging by Payer.

Billing Ledger: Report of claims/invoices submitted, payments received broken out by primary funding source and client responsibility, and secondary and tertiary if present; copay, coinsurance, and deductibles for client responsibility.

Billing Follow-ups: Report that shows all Follow-ups that were entered for charge lines, including Follow-up date and note. Users are able to use this report to track the items that need to be acted upon.  This report was formerly called Charge Line Follow-ups.

Client Aging: Aging report that shows client outstanding balances by aging buckets as well unbilled charges.

Insurance Appointments Check:  Used to verify that appointments are ready for billing before generating claims.  Information included in the report including

  • Is appointment rendered?
  • Is there a diagnosis code?
  • Is there a service location?
  • Is the appointment overlapping with another service appointment?

Insurance Details Ledger:  Report of all line items on an invoice.

Invoice Appointments Check:  Used to verify that appointments are ready for billing before generating invoices.  Information included in the report including

  • Is appointment rendered?
  • Is there a vendor ID?
  • Is the appointment overlapping with another service appointment?

Payment Ledger Report: Report of funding source and client responsibility payments received, including payment amount and any portion of a payment that has not yet been applied to a claim, client statement, or invoice line item.

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