penelope CREATE AN EOB ATHENA SOFTWARE Last updated: January 22, 2015

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1 penelope CREATE AN EOB ATHENA SOFTWARE Last updated: January 22, 2015

2 process flow: add an eob 1. Create the EOB file and specify the payment method, amount, and details. 2. Add an EOB line to the EOB details using the EOB Line Wizard. 3. Filter and view the line item results. 4. Select the line item you want to provide payment details for. 5. Specify explanation, status, and adjust group codes if desired. 6. Choose a payment detail option. 7. Specify payment details as needed. 8. Repeat steps 2-7 until you ve completed your EOB.

3 create the eob

4 about the eob feature THE BASICS Many funders provide an Explanation of Benefits (EOB) document when sending payments to organizations. The EOB explains which services the payment is for. The EOB feature in Penelope enables you to enter the details from the EOB into the database. You can apply payments, make adjustments, and/or apply recovery charges to the client.

5 create the eob STEP 1 On your homepage, in the Links sidebar, click Create EOB.

create the eob STEP 2 a) In the Reason drop-down list, select the payment method or type. b) In the Date field, select the date of payment. c) In the Total field, type the total payment amount.

6 create the eob STEP 2 a) In the Reason drop-down list, select the payment method or type. b) In the Date field, select the date of payment. c) In the Total field, type the total payment amount. d) In the Check No field, type the check or transaction number if applicable. e) In the Description field, type a description of the payment. f) In the Received by Site dropdown list, select the site the payment was received at. g) If applicable, on the Add to Deposit drop-down list, select which deposit you want to add the payment to. h) Click Save.

7 add an eob line item

8 about adding a line item to the eob THE BASICS The Detail section in the EOB includes the Add feature for adding individual line items to the EOB. The Detail section will subsequently list the payment details as you have entered them in the database. The Totals section displays a running total of the EOB payment amount, how much has been applied, and the remaining unapplied balance.

9 add a line item to the eob STEP 1 In the Detail section, click Add.

10 add a line item to the eob STEP 2 In the View By section, choose at least two fields including Funder to filter the search results. STEP 3 Click View. Note: Search results are limited to the first 500 lines matching the filter criteria. If you do not see the line item that you are expecting, include additional search criteria in the View By section.

11 add a line item to the eob STEP 4 In the results, select the appropriate line item for which you want to enter EOB details.

12 input payment details STEP 5 If desired, in the Explanation Code section, type the explanation code as provided by the funder. STEP 6 If desired, in the Status Code dropdown list, select the status code as provided by the funder. STEP 7 If desired, in the Adjust Group Code drop-down list, select the adjust group code as provided by the funder.

13 input payment details STEP 8 In the Payment Details section, select the appropriate option. PAYMENT DETAILS Payment! WHEN TO USE When the funder has provided payment in full against the applicable invoice/line item. Denied (no adjustment)! When the funder has denied the claim in full, and you want the charge to remain on the funder s account as outstanding. Credit Adjustment! When the reimbursement amount is less than the invoiced amount or when the funder has denied the claim in full and you cannot recover the balance from the client. You can use credit adjustment to write off the invoice or apply a partial payment to the claim and credit the difference to the funder s account. Debit Adjustment! Return Units! When the reimbursement amount is more than the claimed amount. You can use debit adjustment to add additional charges to the funder s account (for example, interest payments). When you want to return an invoiced service unit to a policy coverage and credit the payor's account for the returned amount. Recover Units! When you want to credit the funder's account for the recovered amount and then charge the balance to the client s account. This option is often used to track deductibles.

14 ! input payment details STEP 9 Depending on the Payment Details option that you select, click Next or Finish. Note: Depending on the Payment Details option you select, your next steps will vary. The following slides walk you through how to input payment details for each option. OPTION 1 OPTION 2

15 input payment details

16 input payment details: payment STEP 1 In the Amount Received field, confirm or type the total amount received for the line item. STEP 2 To apply the payment, click Finish.

17 input payment details: denied (no adjustment) Note: After clicking Finish, no further action is required.

18 input payment details: credit adjustment Note: The Amount Received field is automatically populated with the total invoiced amount. When you adjust this to the actual amount paid by the funder, the Amount of Credit line will adjust accordingly so the two amounts equal the Invoiced Total. STEP 1 a) In the Amount Received field, type the total payment received. b) In the Amount of Credit field, verify the credit amount. c) In the Reason drop-down list, select the reason for the credit. d) If required, in the Description field, type a description. e) In the Issued at Site drop-down list, select the site the credit will be issued from. f) In the Service drop-down list, select the Case Service the credit will be associated with. STEP 2 To apply the payment and credit, click Finish.

19 input payment details: debit adjustment Note: The Amount Received field is automatically populated with the total invoiced amount. STEP 1 a) In the Amount Received field, type the total payment received. b) In the Amount of Debit field, verify the debit amount. c) In the Reason drop-down list, select the reason for the debit. d) If required, in the Description field, type a description. e) In the Service drop-down list, select the Case Service the debit will be associated with. STEP 2 To apply the payment and debit, click Finish.

20 input payment details: return units Note: The Units to be Returned field is automatically populated with the original quantity invoiced. If required, you can adjust the quantity if the funder paid for some but not all of the quantity charged. The Amount Received field is set to 0.00 by default. If this amount is changed, the Amount Remaining field automatically updates to reflect the difference between the invoiced and received amounts. A partial return (where some but not all of the service units were paid) can be recorded by entering the quantity of service units not paid for and the payment amount received for the units that were paid. STEP 1 a) In the Units to be returned field, confirm or type the number of units to be returned to the policy. b) In the Amount Received field, confirm or type the amount received. STEP 2 To apply the return, click Finish.

21 input payment details: recover units Note: The number of service units being recovered (i.e. returned to the policy) will default to the original quantity invoiced. You can adjust this value if the funder paid for some but not all of the units charged. If the service unit was covered by a policy, then the unit(s) and/or dollar amount(s) will become available for use again. The Amount Received field is set to 0.00 by default. If this amount is changed, the Amount Remaining field automatically updates to reflect the difference between the invoiced and received amounts. If a payment was previously applied to the invoiced service unit(s), it will become an unapplied payment. The Adjustment amount (the amount being recovered and charged to the client) automatically updates to reflect the difference between the invoiced amount and the amount paid by the funder. If a client was charged a Co-Pay, it will be credited back and included in the adjustment amount being recharged to the client. STEP 1 a) In the Units to be recovered field, confirm or type the number of units you want to recover from the funder and charge to the client. b) In the Amount Received, confirm or type the payment received. c) In the Reason drop-down list, select the recovery reason. STEP 2 To apply the recovery, click Finish.

22 add additional eob line items

EOB The Totals section displays a running total of the EOB payment amount, how much has been applied, and the remaining

23 add additional eob line items Continue adding all of the line items as they show up on the EOB provided by your Funder. Note: The Invoice Number filter is remembered for the duration of your browser session when adding multiple lines to an EOB The Totals section displays a running total of the EOB payment amount, how much has been applied, and the remaining unapplied balance. As you add in the line items, you can ensure your totals match up and that the EOB has been fully applied.

tip: find the eob after the fact If you need to find the EOB after the fact to continue adding line items, review, or make adjustments, you can use the Search feature to locate the EOB.

24 tip: find the eob after the fact If you need to find the EOB after the fact to continue adding line items, review, or make adjustments, you can use the Search feature to locate the EOB. STEP 1 In the Search feature, on the Billing tab, click EOB. STEP 2 If required, type any Search Criteria. STEP 3 Click Go. STEP 4 In the Results section, click the appropriate EOB ID.

25 after you finish

26 after you finish DOCUMENTS On the Documents tab on the EOB page, you can see a summary of all the Documents associated with the EOB including invoices, payments, recoveries, returns, credits, and debits.

27 after you finish REPORTS The EOB Detail Report includes a summary of all information entered for the EOB. To see a printed copy of the EOB, click the Print option.

28 to view more tutorials, visit

Guide to Credit Card Processing

CBS ACCOUNTS RECEIVABLE Guide to Credit Card Processing version 2007.x.x TL 25476 (07/27/12) Copyright Information Text copyright 1998-2012 by Thomson Reuters. All rights reserved. Video display images