If you are using a Clearinghouse, you will need to post the 835 file that is returned from the insurance company containing payments to your client accounts. This file is imported into the PIMSY system to make it easier for you instead of entering payments singularly.
Fields & Buttons:
EDE Batch # - number for this posting. Every EDE file will receive a Batch number, which starts in numerical order at the beginning of your use in PIMSY.
EDE Category – Tells PIMSY what type of file to prepare for. For posting you must select the “835 option”.
Active – If the particular EDE was active at any point.
Description – we recommend using the file name from the file you import so you can locate it in the clearinghouse in the future if needed.
Billing Location – You will not need to fill this out for processing an 835.
Processed – The system will check this box once the file has been processed.
Processed By – PIMSY will automatically fill in the user’s name once the “Update” button has been processed.
Processed Date – The system will automatically stamp this when it stamps the “Processed By”.
Misc. Notes – When PIMSY processes the ERA, it will extract the amount of the check along with any available information, such as payer name and check date, amount processed, and any difference. If there were multiple payments in the 835, it will break that down if they came in separately in the 835. Additionally, if there are any claims that PIMSY was unable to identify, you will see a remark “There were claims that could not be processed”.
EDE File – This is the data that PIMSY sorts through to post the payments to each invoice in the system.
Search button –Button cannot be used
Go to Invoicing for EDE – view invoices directly involved with this 835.
How to post payments once you have the 835 on your desk top:
- Go to Utilities at the top left of the menu.
- Select EDE (Electronic Data Exchange)
- On the top right, select your EDE Category (835- RA Payment Posting 835).
- Enter a description (we recommend the EDE number from the file you bring in so you can match it up if needed later). The filename will be automatically entered.
- Save it at the top of the window.
- Click the Retrieve button top right.
- Select one 835 file or multiple 835 files to import at one time. You can double-click on one file to download but for multiple selections, click the Download button.
- When you have finished retrieving your 835 file(s), click the Update button on the top right of the main import window.
PIMSY will ask if you want to view a Prelimary Run to see what is in the 835 file.
- On the bottom, right, click Go to Invoicing for EDE. This will take you to the invoicing page where we recommend you look over the claims to see if there is anything that doesn’t look right. If there was a denial reason you should find it in the Remarks Private
We also recommend once you bring a batch in, move that file onto your computer to a new folder called Posted so you don’t accidentally post it a second time. Any balance will automatically become the patient’s responsibility. If everything else looks good you are finished.
To locate all EDE files, Go to Utilities, then EDE. This will retrieve all EDE files that have been generated. The 837 and 835 files are housed here and in order of date with most recent on top.
Manually Post Payments
In the Invoicing screen, Filter for the Client and Date of Service for which the payment was received.
Check the box for Payment Received.
- Enter the Amount the Payer paid on the appropriate line. Make sure this is posted on the correct line (insurance payment on insurance line, client payment on the co-pay/deductible/self-pay etc.).
- Enter amount written off according to the EOB.
- Pull down the Payer Control # by right-clicking on the column headers. Locate the number that identifies the claim on the EOB. Enter this number in the box in PIMSY. It will be necessary if you ever need to file a resubmission.
- Enter the EOB Date.
- Click Save.
- Check the EOB for any patient responsibility. In the bottom portion of the Invoicing screen, if any payments were taken at the time of service, there will be another line reflected here. It will either be under Co-pay, or Deductible or Co-Insurance. If there is not, click Copy on the insurance line.
- Change the Insurance Payer on the second line to the appropriate self-pay type (co-pay,deductible, co-insurance.
- Check the Invoice box, and in the Amount Invoiced field, invoice for the amount of the patient responsibility. This will now show up on the client’s statement, as well as provide a place to post the client’s payment when payment is made. Click Save.
Clinician Marcia Smith has seen client Kelly Clark for an hour session (90837) and billed her insurance company BCBS $135.00. Kelly has a $25 copay. Marcia did not know this at check in. When the session came back paid, BCBS agreed to the allowed amount of $95.00, and paid Marcia $95.00. Marcia must write off $20.00, and now collect the $25.00 copay from Kelly. PIMSY will track the totals in the bottom right corner to make sure the proper amounts are there for Marcia’s use.
If you cannot find what you need in this article, please contact Support (email) or call 877.334.8512 ext. 3.