Document a Charge

Search the desired claimants from any specific sub tab (Claimants, Claim Log, Notification Log, or Reserves)..

Click the desired claimant from the list.

Click the Claims button.

Select the desired submission from the drop-down.

Click the Audit Charges sub tab then click New to display the TPA Paid Claims window.

Document the charge as follows

Dates of Service

Use the first field to enter the date service was first received. Use the second field to enter date service was last received. Enter dates directly into the fields in MM/DD/YYYY format or click the calendar icon and set the date using the date picker tool.

Billed Charges

Enter billed charges here. Check the Misc Provider box for miscellaneous providers.

Healthcare Provider

Miscellaneous Provider

Click the button and specify the healthcare or miscellaneous provider from the Company Search window.

Less: PPO Discount / Network

Enter any amount applying toward PPO or network discounts and select the PPO or network from the drop-down menu.

Less: Deductibles, Copay, etc.

Enter any amount applying toward deductibles, co-pays, etc.

Less: Negotiated Amount / Vendor

Enter any amount deducted as a result of negotiated agreements with the vendor, then click the button and specify the vendor using the Company Search window.

Administrator Paid Amount / Paid Date

Amount paid to the administrator. Calculated by ESL Office. Specify paid date in the date field next to the amount. Enter the date directly in the field in MM/DD/YYYY format or click the calendar icon and set the date using the date picker tool.

Less: Denied Charges

Denied charges. Subtracted from reimbursement amount. Calculated by ESL Office based on any denied adjustments you make.

Less: Pended Charges

Charges on hold (pended). Subtracted from reimbursement amount. Calculated by ESL Office based on any pend adjustments make.

Allowable Amount

Allowable amount for reimbursement. Calculated by ESL Office.

Less: Excess of Reimbursement Limit

Amount in excess of the reimbursement limit. Calculated by ESL Office. Specify the excess limit percent in the field next to the amount.

Reimbursement Amount

Amount qualifying for reimbursement. Calculated by ESL Office based on billed charges and all deductions.

Service Type

Specify service type using this drop-down.

Claim No

Enter the claim number here.

CPT Code

Enter the CPT (Current Procedural Terminology) code here.

If you need to create a denied or pended adjustment, click New under the Denied / Pended subtab to show the Specific Adjustment window, and document the adjustment as follows.

Adjustment Type

Check the box next to the type of adjustment you are making.

Note: If you check Pend, the reserve increases by what you put in the Amount field. However, releasing the pend will not release the reserves by the pend amount. Reserves are only released when payment is made and only for the amount of the payment. This means if you create a pend specific adjustment for an amount greater than the claim payment, your reserve will retain any amount over the payment.

Amount

Enter the adjustment amount here.

Description

Select the appropriate adjustment description from the drop-down. Adjustment descriptions are defined by your ESL Office administrator.

Comment

Provide any additional comments regarding the adjustment here.

Provide any desired comments for the charge in the Comment text area.

Click Save.