Summary:
This article explains how patient payments are allocated in the system and clarifies why certain payments may appear aged or misaligned with expectations on the ledger. It addresses a specific case involving payment allocation and aging concerns.
Key Concepts
1. Claim Closure Timing
- Payments do not allocate to services until the associated claim is closed.
- Example:
- Date of Service: 11/20/2024
- Claim Closed: 08/06/2025 at 6:09 AM PST
- Payment will now allocate to this service since the claim is closed.
2. FIFO Allocation Method
- The system uses FIFO (First In, First Out) to allocate Responsible Party payments.
- Payments are applied to the oldest patient portion balance first.
- Example:
- Credit Card Payment: $92.10
- Date of Service Allocated To: 05/21/2025
- Claim Closed: 06/04/2025 at 7:27 AM PST
- The payment was applied here because it was the oldest eligible balance at the time of claim closure.
Ledger Clarification
- Outstanding Balance: $154.85
- Aged Portion (Over 120 Days): $92.10
- Concern: The $92.10 was paid in January, so why is it still showing as aged?
Explanation:
- The payment was made in January but could not be allocated until the claim for 05/21/2025 was closed in June.
- The system then applied the payment to that service using FIFO.
- The aging reflects the date of service, not the payment date.
- This is expected behavior and does not indicate a system error.