Payer claims and remittances

When to use payer claims

Use Finance > Receivables > Payers & Claims for orders billed to an insurance company, corporate payer, hospital, or another contract payer. Patient cash orders do not need a payer claim.

Before creating or sending a claim, check the contract, patient, order, covered services, total, and authorization status. One order should not be submitted twice.

Submit and follow a claim

Create the claim from the eligible order. If authorization is required, record the authorization decision and reference before sending. Use Submit claim only after the claim details and supporting documents are ready. The submission starts the payer balance and due-date tracking.

Use Mark as received when the payer confirms receipt. For a denial, record the denial code and reason, then use the appeal workflow after corrected documents are ready. Keep the payer reference in the claim timeline.

Record a remittance

Choose Record remittance when the payer sends money or a remittance notice. Select the actual cash or bank account and enter the payer reference. Apply the received amount, contractual adjustment, and denied amount; their total must not exceed the outstanding balance. Partial remittances leave the claim open, while a fully applied balance closes it.

Review the aging view in Receivables and follow overdue claims with the payer. Do not reuse a remittance reference or enter the same bank notice twice.