Permissions: Users need the Billing Permission to work with Remits.
When you receive remittance advice from a payer outside of Fusion, you'll need to record that information in Fusion so you can finalize its claims to the next payer or to the billing account. Follow the steps in each section below to record a Remit.
In This Article
- Add the Remit
- Fill in Adjudication Information
- Finalize Claims from the Remit
- Link Claims to the Remit
- Add Provider-Level Adjustments
Add the Remit
NOTE: Avoid Duplicates. Don't manually add a Remit for a payer that sends you electronic remits in Fusion unless you know it won't come in automatically. To enroll for ERAs with a payer, reach out to your Customer Success Manager.
- Go to Billing > Remittance > Received to add a remit you have received from a payer.
- In the lower right of the Received Remittance page, click the + Remittance button.
- Fill in information about the remit.
Payer The payer who sent the remit. You can either select a payer or type in a custom name. Date The date of the remit's payment. Amount The total amount the payer paid in the remit. Type Indicates whether the remit was paid by check or EFT. Number The payment's reference number, such as a check number. Billing Provider The name of the billing provider listed on the remit. Identifier Type Indicates whether the remit refers to the billing provider with an NPI or Tax ID. Provider NPI / TIN The NPI or TIN listed on the remit for the billing provider.
- Click the Save Remittance button.
TIP! You can upload a copy of the remit's original file as a PDF. Check out this article on how to upload a PDF to a Manual Remit.
Link Claims to the Remit
Once you have a remit in Fusion, link it to each claim the remit applies to.
- From the Received Remittance page, click the remit you want to link claims to.
- In the lower right, click the + Claim button.
- Select the checkbox next to one or more claims.
TIP! If you do not see the claim you are looking for, adjust the filter in the upper right.
- Click the Link claims to remittance button.
Fill In Adjudication Information
For each claim in the remit, fill in the adjudication information, which indicates how and why the payer paid the claim.
- From the list of claims linked to a remit, click the claim you want to fill in adjudication information for.
- If needed, modify the information in the Summary tab. Most of this section will automatically be filled in.
Date The date this claim was processed by the payer. Reference The reference number the payer assigned to the claim. Patient The patient's name on the claim. Insured Name The insured's name on the claim. Insured ID The insured's ID number on the claim. Group Number The insured's group number on the claim. Notes Notes about this adjudication that you want to save for your reference.
- For each Line table, fill in information about how the payer paid toward that service line. When all of the charges submitted for the line have been allocated, the amount remaining above the Date of Service will show .
TIP! If you need to add a new line to the adjudication, click the + Line button in the lower right.
Date of Service The date of service this line applies to. Procedure Code The billing code that was processed by the payer for this line. Charges Submitted The charge amount for this line that was submitted to the payer. Charges Paid The amount that was paid by the payer for this line. Units Submitted The number of units for this line that was submitted to the payer. Units Paid The number of units that were paid by the payer for this line. Allowed Amount The portion of the charge amount that this payer allows. Not Allowed The portion of the charge amount that is beyond what the payer allows. This amount is saved as a "contractual obligations" adjustment (code 45). Other Payers The portion of the charge amount that has already been paid by, or should be paid by, another payer. This amount is saved as an "other" adjustment (code 23). Co-Pay The portion of the charge amount that the patient owes as a co-pay. This amount is saved as a "patient responsibility" adjustment (code 3). Deductible The portion of the charge amount that the patient owes as a deductible. This amount is saved as a "patient responsibility" adjustment (code 1). Co-Insurance The portion of the charge amount that the patient owes as co-insurance. This amount is saved as a "patient responsibility" adjustment (code 2). Submitted Code The billing code for this line that was submitted to the payer. Adjustments Add any additional adjustments the payer used to process the line here. Click the adjustment codes icon to look up a description of the saved code. Remarks Add any remark codes the payer used to process the line here. Click the remark codes icon to look up a description of the saved code.
- If needed, fill in the information in the Claim tab about how the payer adjudicated the overall claim. This is not common and should only be modified if the payer did not provide information about specific service lines.
- In the lower right, click the Save Adjudication button.
Add Provider-Level Adjustments
If the remit includes any adjustments that don't apply to a specific claim, you can add them as provider-level adjustments to offset the remaining payment amount.
- From the list of claims linked to a remit, click the Provider-Level Adjustments tab.
- In the lower right, click the + Adjustment button.
- Fill in information about the adjustment.
Date The date of the adjustment. Amount The adjustment amount. Code The reason code provided for the adjustment. Click the reason codes icon to view a list of typical codes. Reference The adjustment's reference number.
- Click the Save Adjustment button.
Finalize Claims from the Remit
Once a claim's adjudication information has been added to a remit, you can finalize the claim to the next payer or to the patient's billing account. The Next Step column indicates which of these will happen when you finalize each claim.
- Finalizing to the next payer creates a new instance of the claim that can be sent to the payer.
- Finalizing to a billing account adds the total of any Patient Responsibility adjustments to the account's statement as a charge.
TIP! If the current payer did not assign any patient responsibility, Fusion will skip the remaining payers by default. If you want to choose whether to finalize a claim to the next payer or to the patient's billing account, you can finalize it from the claim form instead.
To finalize the claims on a remit:
- From the list of claims linked to a remit, select the checkbox next to one or more claims.
- In the lower right, click the Finalize button.
- To confirm that you want to finalize the selected claims, click the Finalize Adjudications button.
NOTE: If a claim has a red icon next to it, then too much or not enough of the submitted charges have been allocated on remits. You'll need to balance the claim before it can be finalized.