Reimbursement Details in Healthie
Healthie makes it easy to track and manage claims from end-to-end. If you've integrated a clearinghouse with Healthie, such as Claim.MD or Office Ally, reimbursement details will automatically be updated when the ERA data is sent into Healthie. Alternatively, you can manually adjust the reimbursement details for a claim at any time.
To access reimbursement details:
- Navigate to Billing > CMS 1500s
- Click the [...] next to a client claim > Reimbursement details
Within the Reimbursement Details section, you'll find the following information:
- Client Name and DOB
- Provider Name
- Status of the Claim (ie. Partially Paid, Fully Paid — see a description of all claim statuses here).
- Amount Billed — this is automatically calculated based on the billing details of the claim you submitted.
- Insurance Discount (if it applies)
- Reimbursement Amount and Date
- Amount client as already paid — you can manually enter the amount a client has paid prior to the claim being submitted.
If you are using Healthie's integration with Claim.MD or Office Ally, the claim status and reimbursement details will automatically update within Healthie. You must complete ERA enrollment if the payer requires it (which can be done in your clearinghouse account).
Reconciling Client Owed Amounts
Most commonly providers will invoice clients and/or charge their payment card on file to collect any client owed amounts such as copays, deductibles, or declined charges.
As best practice, we recommend creating an invoice and associating it with the client CMS 1500. When creating an invoice for a specific claim, the client-owed amount will automatically populate into the invoice.
How to invoice a client for a client owed responsibility:
- Navigate to Billing > Payments > Invoices
- Invoice Type — select CMS 1500
- Recipient — select the client
- CMS 1500 — select the corresponding claim (submission) date
- Client Responsibility — this will automatically populate based on the Reimbursement Details for the claim.
Optionally, you can choose to write-off the claim (ie. in the event of a billing error).
Once an invoice has been created, you'll see a record of it under Payments > Invoices.
You can also use the option Notes section of the Reimbursement Details as a reminder that an invoice was created for this charge.
Once the invoice is paid, the client owed amount will be fully resolved and the claim status can be updated to Fully Paid.
As part of your billing workflows, we recommend running the CMS 1500 Report regularly for your account and reconciling any unpaid claims.