A patient’s purchase view displays an estimate of what the patient and payor are expected to owe, as well as the actual responsibility breakdown once the ERA has been posted.

Here is a breakdown of Estimated Responsibility: 

The Estimated responsibility breakdown will display initially on a purchase. After an ERA has been posted, this will update to display the Actual responsibility.

Payor Total is the estimated amount that the payor will reimburse for your billed service codes. 

Contraction adjustment is the estimated amount that you will write-off once the ERA is posted. This is the difference between the total billed amounts and the total allowed amounts. 

Patient responsibility is the estimated amount that the patient will be responsible for according to their insurance policy.

Invoiced patient responsibility is the sum of the patient's estimated insurance responsibility and the total of any non-billable charges. 

The estimated responsibilities are based off of the Allowed Amounts you've entered in your Billing codes database and the patient's insurance benefits entered for their policy. 

Quickly view this information on the purchase by opening up the Insurance drop-down. This will display the patient's benefits as well as the allowed amounts for each service code. 

Here is a breakdown of Actual Responsibility: 

The Payment Summary on the patient's purchase will update with the Actual amounts listed on the ERA once the associated ERA has been posted. 

If you would like to see the Estimated values after the ERA has been posted, click on the Show Estimates to show the Estimated values next to the Actual. If these values are different, we recommend reviewing your set Allowed amounts and patient benefits to ensure that this purchase is accurate, and so they are accurately entered for next time. 

Payor total is the actual amount that the Payor paid on the claim. 

Contractual adjustment is the actual difference between your Billed Amount and the payor's Allowed amount. 

Patient responsibility is the actual adjudicated patient responsibility that is notated on the claim. 

Note: Invoiced patient responsibility will still reflect the estimated patient responsibility.