User Guide — Bulk Payment Posting

athenaCollector

A "bulk payment" occurs when a payer sends remittance for a single claim with multiple charges but does not specify how to apply the payments, transfers, and adjustments to each individual charge.

 

If remittance covers multiple charges on a single claim, the payments, transfers, and adjustments must be distributed across the charges, so that the claim can close or move to the next appropriate status.

  1. If there is a copay transaction, the full copay amount is posted to only the first charge on the claim.
  2. All other transactions are distributed across the claim by:
    1. Determining each charge's percentage of the total sum of charges on the claim.
    2. Posting all non-copay transactions across all charges, based on each charge's percentage of the claim.

 

 

For example, suppose Claim A has these two charges:

  • The sum of all charges on the claim is $100.00.
  • Charge 1 is $80.00, which is 80% of the claim.
  • Charge 2 is $20.00, which is 20% of the claim.

An ERA record comes in matching Claim A but contains these details:

  • Charge amount: $100.00
  • Payment: $50.00
  • Coinsurance: $30.00
  • Contractual adjustment: $20.00

athenahealth would apply this bulk payment as follows (the provider is not listed as NONPAR for the insurance package on the designated date of service):

  • Charge 1 is 80% of the total charges on the claim, so 80% of each remittance transaction type is posted to this charge: $40.00 payment, $24.00 coinsurance, $16.00 contractual.
  • Charge 2 is 20% of the total charges on the claim, so 20% of each remittance transaction type is posted to this charge: $10.00 payment, $6.00 coinsurance, $4.00 contractual.

 

 

Our posting policy follows the Florida MVA 80/20 rule. Florida MVA insurance regulations state that there is an 80/20 split on the state-defined allowable amounts in relation to services rendered for an MVA injury—80% of the allowed amount being paid by the insurance carrier, and the remaining 20% being the responsibility of the patient. Any amount in excess of the state-defined allowable amount will be posted as a contractual adjustment.

 

Note: Only the following states have defined MVA allowable schedules:

  • Florida
  • New Jersey
  • New York
  • Oregon
  • Pennsylvania

athenaOne has imported state-defined MVA allowable schedules for:

  • Florida
  • New Jersey
  • Oregon

athenaOne has imported state-defined WC allowable schedules for:

  • Florida
  • Texas