Remittances
Every remittance received, and the posting each one produced.
Who Can See It
Section titled “Who Can See It”User, where the client is licensed for remittances. Posting a reversal, a manual adjustment or a supersede on a remittance also needs Manager or Administrator; without one, those actions are missing from the card menus.
The List
Section titled “The List”Tiles above the list count the Total. While remittances are held, Held, Held Amount and Oldest Held show the backlog, and selecting any of them turns the Held posting filter on or off. The search box matches the check number, trace number, payer, payee and claim number.
| Column | What it shows |
|---|---|
| Remit # | The check number, or the trace number or ICN when the payer sent no check number |
| Claim # | The claim this remittance matched |
| Status | What the payer did with the claim, and Secondary or Tertiary when the remittance belongs to a secondary or tertiary claim |
| Exceptions | Findings the remittance rules raised |
| Payer | Who sent it |
| Claim Amount | What was billed |
| Paid | What the payer paid |
| Posting | Where the remittance stands: Held, Posted, Reversed, Superseded, Returned to Payer or Overturned |
| Patient Resp. | The patient responsibility the payer reported. When the patient has another coverage active on the date of service, posting moves this amount to a secondary claim for that payer instead of to the patient, so the patient owes nothing until the secondary decides. A secondary’s remittance moves it on to a tertiary claim the same way when a third coverage is active |
| Payment Date | When the payer paid |
On a screen narrower than 1536 pixels, Claim #, Claim Amount and Patient Resp. are hidden and the claim number shows under the Remit #.
A remittance reads Held until its review closes, Posted once the money reached the ledger, Reversed after a posting was backed out, Superseded when a later remittance replaced it, Returned to Payer when it was closed as not the practice’s money, and Overturned when it is a posted denial whose appeal the payer later paid. The Posting filter offers each of the six.
Filters
Section titled “Filters”| Filter | What it keeps |
|---|---|
| Posting | Remittances in one posting state |
| Payer | Remittances from the payers you pick, matched on the payer in the 835 or the claim’s payer |
| CARC | Remittances carrying that adjustment reason. Type it with its group, such as CO-197, to match that group only, or as the bare code, such as 197, to match it under any group |
| Received | Remittances your practice received between the two dates |
| Paid | Remittances with a payment date between the two dates |
Selecting a CARC on the Denial Analysis report opens this list with CARC and Received already set to that code and the report’s dates. The list can show more remittances than the report counted: it keeps every remittance carrying the code, while the report leaves out adjustments it does not class as a denial and denials closed as Combined Into Another Claim or returned to the payer.
The Remittance Page
Section titled “The Remittance Page”| Card | What it carries |
|---|---|
| Remittance | Payer, check or EFT reference, dates, and the patient on the 835 |
| Amounts | Billed, adjustments, patient responsibility and paid. Its menu holds Post Reversal and Supersede |
| Check | The check or EFT the remittance came on, when the 835 sent a check amount or a provider-level adjustment |
| Resolution | The reviewer’s decision and notes, required before a review closes |
| Claim | The claim this remittance matched. Its menu holds Reassociate Claim |
| Adjustments | Claim-level adjustments. Its menu holds Post Manual Adjustment |
| Service Lines | Line-level adjudication as the payer reported it |
Findings sit on their own tab.
The remittance itself has its own page: The Remittance Page.
States
Section titled “States”- Held - nothing posts until the review closes. Saving a decision on the page says
Resolve the item in Remittance Review to release the posting. - Posted shows the date and notes that corrections post new entries rather than editing old ones.
- Nothing to post says so plainly when a remittance carries no payment and no adjustments.
- Superseded - closed without posting because a corrected remittance replaced it.
- Returned to Payer - closed without posting because the money was not the practice’s; the refund is issued outside ClaimPod.
- Where the 835 omitted a field, the page says what it substituted, such as using the claim’s insurance plan.
- Empty - a client that has received no remittances says so; they arrive from the payer, never by hand.
- Blocked - without the remittances module the screen is not in the sidebar, and a saved link to it says the module is not part of your plan.
Related: The Remittance Page · Payments Look Wrong · Work a Remittance Review Item · Post an Adjustment or Reversal