One of the most important steps when adding a Claim to an invoice is the proper designation of who will be receiving payment.
Claim Payable to Clinic or Provider
When a claim is payable to a clinic or provider, the invoice will be evaluated based on the EOB (Explanation of Benefits). If an EOB has not been added, the Insurer will be responsible for the full balance.
In the example below an EOB has been added and the insurer is responsible for $90 and the patient is responsible for $20.
Claim Payable to Insurer Member, Patient, or Adjudicator Guarantor
When a Claim is payable to the insured member, patient/client, or adjudicator guarantor, the full balance will always be allocated to the patient/client regardless of the EOB. When the invoice is paid by the patient or client, the EOB needs to be updated to Paid.
The claim has been changed to Payable to Patient in the example below.
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