Post by peter@crystalpm on Apr 28, 2014 11:41:47 GMT -6
When you send out claims in an ANSI file, Crystal will attach a reference number to the service line. This reference number should be returned with the EOB information so Crystal can easily match the payment to the claim. However there are situations where this process breaks, for example, if you send paper claims there is no reference number to match, and if medicare sends to a secondary insurance the reference number is lost somewhere.
In cases where there is no reference number that matches a claim, we try to match the patient name. This must be an exact match on first and last name and also match the CPT codes on the claim lines. Many failures here are caused by a mismatch of spelling between the insurance company and Crystal.
Between the two matching schemes, we should correctly match payments for over 99% of patients. There will be some patients that we can not automatically match, and these payments will need to be entered manually.
In cases where there is no reference number that matches a claim, we try to match the patient name. This must be an exact match on first and last name and also match the CPT codes on the claim lines. Many failures here are caused by a mismatch of spelling between the insurance company and Crystal.
Between the two matching schemes, we should correctly match payments for over 99% of patients. There will be some patients that we can not automatically match, and these payments will need to be entered manually.
