Document Insurance Checks

CILe - Client Information Ledger

How does CILe help me track which claims have been paid?

CILe helps you document the incoming insurance checks in the Insurance Payment Maintenance screen.

You access the Insurance Payment Maintenance screen off of the Fiscal Menu (shown above), or from the Client Pop-up Menu.

Click on any field in the screenshot below to jump to the explanation of that field, and click the up-arrow to return to the screenshot. Return to this screen when you have a chance to make phone calls to the insurance company to find out why claims haven't been paid yet. Go to "Research Outstanding Claims" for a full explanation of that process.

1) Insurance Payment Maintenance screen	This screen allows you to have all of the information you need pertaining to a specific date of service, the amount charged, the copay you charged and the copay the insurance company allowed, etc. This allows you to research your outstanding claims with the insurance company on the phone (or on-line), and have all of the information they will need for the services you are researching. You can come into this form from the Fiscal menu or from the client pop-up menu. If you come in from the Fiscal menu, you will see all outstanding claims for all clients. If you come in from the client pop-up, you will only see the outstanding claims for that specific client. you will find one or the other more convenient, depending on what you are trying to accomplish.
2) Show All for Client button	When you first come into this screen, you will only see the claims that are still outstanding. If you would like to see the dates of services that have been paid as well, click this button. It will display all of the dates of service in the database for this client, both paid and unpaid. If you have displayed this screen from the Fiscal menu, you will be looking at all of the client's outstanding claims, but clicking this button will take you to only the client whose name you have clicked on the listing. Over time, there will be too many claims to show all paid and unpaid claims for all clients, so it limits the "all" listing to only a single client. If you starting from the "all clients" screen, when you click the button again, it will show the outstanding claims for all clients again. If you started from the client pop-up menu, then you will toggle back and forth between outstanding and all dates of service for only that single client.
3) Verify Check Number button	Many of the checks you receive from the insurance companies will have multiple clients and multiple dates of service listed. If you are using this screen to track the ones that have been paid, then you could lose track, miss something, or type in the wrong value. If you have been putting in the insurance check number on each lined, then when you think you are done, click this button. It will allow you to put in the check number, and it will total up all of the values you have entered for this check. You can then compare the value totaled by the computer with the value on the check to be 100% sure you've documented all of the dates of service that were covered by the check.
4) List Pmts for Checknum button	If you have a particularly long report showing the clients and dates of service, and the "Verify Check Number" button doesn't match, you need to figure out which of the values on the report were entered incorrectly. Click this button and enter in the check number again, and it will give you a detailed listing of all of the dates of service you entered. This gives you a convenient way to compare it with the paperwork to see where you made your mistake.
5) Expand Detail Line button	This button gives you access to the note, as well as to the Secondary Insurance information, by expanding the height of the line, exposing the 'hidden' data. Click it again to re-hide them.
6) Search Last Name	When your listing gets long, this gives you a quick way of finding a particular client. Just type in the first few characters of their last name, and you can jump to their name in the listing.
7) Sort Buttons	Click each of these buttons to sort the listing on that column. This allows you to view your data in different ways to allow you to prioritize how you want to do your research.
8) Check All checkbox	The "Research" checkboxes allow you to control which dates of service pop to the top of your list for research, and which ones you might want to push back for a while. By clicking this checkbox, you can either check or uncheck all of the items on your list. If you start with them all checked, then, as you make phone calls and get answers, you can uncheck them. An example would be where you have been told that the check is in the mail. You cannot remove this date of service from this listing until the check actually arrives, so the next time you sit down to make some phone calls, it will still be here and may confuse you as to whether or not you have done the research. When you have a large number of outstanding checks, your memory about which have and have not been researched may not be terribly reliable, so this indicator will become very handy. If the checkbox is unchecked, then you will know you don't need to worry about it right now, and move on to other dates of service to research. By clicking the "Research" sort button, all of the items with this box checked will come to the top of the listing.
9) Client Name	The name of the client as you entered into the "Display Name" on the Fiscal Face sheet.
10) Session Date	The date of service submitted to the insurance company.
11) Note Display	If there is a note associated with this claim, the exclamation mark will be red. Click on the sticky-note icon to display or edit the note. This is the same note that you would see if you click the "Expand Detail Line" button at the top of the screen (already shown as expanded in this screenshot). The big advantage to this feature is that you can see if you have a note without having to constantly expand and collapse the detail lines.
12) Research checkbox	Check this box if you want this date of service to pop to the top of the listing when you click the "Research" sort button. See the explanation on "Check All checkbox" above for a full understanding of what this box does.
13) Date Paid	This is the date on the check that you received from the insurance company, or if you prefer, you can use the date the check actually arrived in your mailbox. CILe doesn't care what date you put here. If you have received a denial of the claim and want to get this item off of this list, put a date in this field and leave the amount paid zero.
14) Session Copay	This is the copay or co-insurance amount the insurance company is requiring that the client be responsible for as reported on the paperwork that came with the check. This will replace what you entered into their session note, so CILe can compare it to what they actually paid when you produce the Accounting report for this client. This way, you can keep track of what they actually owe you, in case your initial impression of their fiscal responsibility was incorrect.
15) Insurance Paid	The is the dollar amount the insurance company paid you for this specific date of service. You will copy this off of the paperwork the insurance company sent you with the check, which lists each client and date of service included separately.
16) Copay Paid	This is the actual copay (or co-insurance) that the client actually paid you on the date of this session. This is just a visual aid to give you confidence you are looking at the correct record. If the client's copay amount is significantly different from the amount the insurance company says they owe, then you can stop and look at it a little more closely, or at least make a mental note that this is something you need to discuss with this client.
17) Insurance Check Number	Enter in the check's check number in this box, and CILe will help you make sure you have entered in all of the dates of service on the insurance paperwork you have recieved, accounting for all of the dollars on the check. By clicking the "Verify Check Number" button at the top of the screen and entering in the check number, CILe will add up all of the dates of service for which a particular check number was entered and tell you the total amount of the dollars you have documented. If they don't match the check, then you know you've missed something and can research it before it later becomes more confusing.
18) Electronic Check	Some insurance companies, including Medicare, do not mail paper checks. Instead, they electronically transfer the funds to your designated checking account. If that is the case, then you do not want this check showing up on the "Deposits to be Done" report, because they've already been deposited and you won't put them on your deposit slip. Since the "Deposits to be Done" report should match the deposit slip, check this box for electronic checks, and they will not be included on the report, but will be included in CILe as having been paid.
19) Loss	This is simply the bad news difference betrween what your hourly fee is and what the insurance company allow for this session.
20) Paper HCFA Printed	This is the date this claim was printed onto a paper HCFA 1500 form. This date is generated when you use CILe to produce the paper HCFA and click "Yes" when it asks if you want these session notes marked as submitted at the end of that process. You may have elected to write out the HCFA 1500 form by hand, but if you use CILe and produce it as if you were going to print it onto the form, then you can use this screen to track its payment.
21) Session Fee	This is the fee you documented on this client's session note for this date.
22) Electronic Transferred Date	This is the date the Microsoft Excel file was created by CILe. This date assumes you uploaded the file to the clearinghouse on that same date, but there is no way for CILe to track that step. You will be able to rely on this date more if you get into the habit of uploading the file immediately on creation.
23) Insurance Company	This is the insurance company that the claim was submitted to.
24) Insurance Policy	This shows whether the insurance company was the primary or secondary insurance company for this claim.
25) Total of Claim	There will be occasions when you will have more than one date of service submitted on a single claim. This is much like the paper HCFA form, where you have the upper portion with the client's personal and insurance information, and the lower portion listing up to six individual dates of service. Each date of service has its own fee, but the total claim has a total of all dates of service, as well. Even with the electronic claims, the insurance companies look up claims by using the "total claim amount." When you are on the phone with an insurance clerk and they ask you the amount of the claim, this is the number you would give them, since it is the total of all of the dates of service that were submitted at the same time, i.e, on the same claim from their perspective.
26) Resubmit Claim	If, as you are documenting or researching this claim, you determine that it needs to be resubmitted, check either of these two boxes (for primary or secondary insurance company), and the next time you go to the "Sessions with no claims submitted" form, they will appear on that listing, ready for creation.

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