-Funding Source Payments

The Funding Source Payments (FSP) submodule in AlphaFlex allows the finance administrator (or any other user with the correct permissions) to view the payments (checks) as well as work denied claims.

Funding Source Payments

The user (those with the proper permissions) will be able to use this submodule to view each check from a payer, view all claims on a specific check, show whether the payments went through AlphaFlex, and work denied claims via rebill, replace, reversal, write off, or bill to the client.

To access the Funding Source Payments screen, click on Financial> Funding Source Payments.

Funding Source Payments (FSP) Screen Overview

The FSP screen has a number of filters for the finance admin to utilize to make it easy to find a payment. This section will review the filters. The user can search using the defaulted values, however, using a combination of the various filters will allow the user to narrow down what is being researched.

Check #- a unique check number can be typed and searched.

Check Date Range- a range of dates can be entered to search for checks within that time frame.

Date Type- two choices- check date (defaulted) or date check was received.

Payer- the user can search for payments from a specific MCO. This is defaulted to ALL.

Benefit Plan- gives the ability to search for payments by a specific insurance company. This is defaulted to ALL.

Notes- entering a word here will allow the FSP screen to search for these words in the Notes category of the Claim Detail Screen (the Claim Detail Screen will be discussed later in this document).

Status- allows the user to search for claims Posted (processed within AlphaFlex) or Unapplied (processed outside of AlphaFlex). This is defaulted to ALL.

*Advanced Payment Search- clicking this link will allow the user to complete a more detailed search. The additional fields of Clinician, Site, Service, Client ID, Client First Name, Client Last Name, Claim Number, and Reason/Remark Code are added.

**This search will only retrieve the top 200 claims unless extra filters are used.

Viewing Checks

One of the main resources within the FSP screen is the ability to view checks and payments that the entity has received. This allows the provider to have a very efficient process of researching income.

Starting from the point where the user has accessed the FSP screen.

1. Click SEARCH. The default values (highlighted in RED below) will show the last 200 checks received. Narrow the results by using additional filters.

2. Checks can be viewed by All Items or Denied Items.

*Please Note: these options will not appear for voided checks.

*A Note about Unapplied Amounts

Unapplied payments are payments that have NOT been applied to a claim in AlphaFlex and will NOT have a claim number.

Searching for and Applying Previously Collected Payments

Once the front desk staff has collected a payment in the Calendar, the finance staff can then search for and apply these payments towards claims in AlphaFlex.

Starting from the point where the user has accessed the FSP screen.

1. Select SELF-PAY for the Benefit Plan. The screen will refresh and the Client ID, Client First Name and Client Last Name fields appear. Enter the search guidelines and click Search.

*Please Note- The user will see any checks for the client. (All payments appear in the system as a check.)

Posted - means that the complete payment amount has been applied to claims in the system.

Unapplied - means that there is a balance on the check that has yet to be applied to claims in the system.

2. Click on the All Items link to open the check. All the claims that have been paid with this check will show in the detail.

3. Click Add Item to pay additional claims with this check.

4. The Post Payment screen will appear and will display the unapplied amount available to apply to claims.

5. Confirm that SELF PAY appears as the choice in the Benefit Plan dropdown.

6. Enter the amount that needs to be applied in the Paid Amt. field and select SAVE at the bottom. *Note- Any unapplied portion of the check can be applied later to future claims.

7. The screen will refresh and will display a receipt that can be printed.

*Please Note- If there arent any claims to apply the payment, that means the claim hasnt been billed yet. Wait until after the claim is billed (billing of approved claims occurs Monday through Friday at 12:00 pm, 3:00 pm and 5:00 pm EST for MCOs and Medicare. For other Benefit Plans billing occurs on Friday at 12:00 pm, 3:00 pm and 5:00 pm EST). Self-Pay/Paper Bill files are created automatically each Friday at 12:00 pm. *If waiting until the billing times is not an option, an 837 can be manually generated at any time. For steps on how to manually generate an 837, please see the document title, Claim Log History in the AlphaFlex University.

Claim Detail Model

Later in this document, users will see how to work claims. Claims are worked in the Claim Detail screen. When clicking on a claim, the Claim Detail Model will open in a pop-up window. The Claim Detail Model will show all of the claim information, links to the note and client as well as any billing history. As already mentioned, the user will work claims and either Rebill, Replace, Reverse, Write Off, or Bill to Client via this screen.

The Claim Detail is accessed by opening the Funding Source Payments screen and then opening a check.

*Note Click ALL ITEMS to open the check details.

Once a check is opened, click on a claim number to view all details.

Users will also see payer details.

As well as any billing history categorized by payer by clicking the + to the left of the banner.

Rebill/Replace/Reverse/Write Off/Bill Balance to Client

In the Funding Source Payment (FSP) screen, the user will have options to take action on a claim that is Paid or Denied. An organization can work a claim to correct what might have been incorrect when it was previously submitted. Entities can work claims that were fully or partially denied or full or partially paid.

Denied Claims (Basic)

Claims that are denied need to be worked to correct the reason for denial. By working a denied claim, the entity can re-submit the claim and receive payment for the previously denied claim.

Starting from the point where the user has accessed the FSP screen and performed a search.

1. Select Denied Items for the desired check on the FSP screen. This screen will give the user the ability to manually work (rebill, replace and/or reverse) the claim.

2. The denied claims for a check will appear.

3. The Finance Admin can take action on the claim by checking any of the available checkboxes and clicking SAVE. *Note- Note every option will be available for every denial.

4. AlphaFlex will then send the claim again and reprocess for payment.

Denied Claims (Detail)

The previous section reviews the process of working a claim without any research being done on the reason for denial. In the below steps, users will see how to research the reason for denial, make the necessary changes to the claim and then have AlphaFlex put the claim back in que to be processed again.

Starting from the point where the user has accessed the FSP screen and performed a search.

1. Scroll through the list of checks and look for any checks that show a number greater than 0 in the Un-Worked Denials Column.

2. Click on the Denied Items link to open all denied claims on that specific check.

3. The screen will refresh and the user will see a list of denied claims.

4. Open the claim details by clicking on the claim number link.

5. The claim details will appear and will allow the user to take action on the claim.

*Note- Not every choice will be available. In the case of this claim, it can be Rebilled, or Billed to Client (shown in red). The other options are currently unavailable. To help with denials, AlphaFlex will only give the appropriate options.

6. Check a box for the appropriate action and all locked fields will open and allow for editing. *Note- In this example a REBILL was chosen. The following steps would be the same no matter the choice made.

7. Make any changes based on the denial reason and check the Approve box.

*Note In this example, the SITE was changed.

8. Click SAVE to store the updated changes. *Note- The fields will again lock and the chosen checkbox will be greyed out. The Claim Status line will have new information. Users can again make a change by first clicking CANCEL EDIT to again unlock the fields.

9. Click the X in the top right corner to return to the list of denied claims.

10. The claim(s) that have been worked and qued will now show with the choices greyed out. Users will know the claim is worked and will not be able to take action until the claim is again processed.

*Note- if it is discovered that a mistake was made in working the claim, click the claim number and following steps 5 9 once again.

Paid Claims (Basic)

Claims that have paid are also available to edit and work. Providers might find this useful in the event that a claim would need to be Replaced or Reversed. *Note that the Rebill option is greyed out and cant be checked when a claim is paid.

A. Replace - Use this option if needing to make changes to a Paid claim and still needing to be paid for it.

B. Reverse Use this option if payment should not have happened. This will send the claim back to the payer so they can recoup the payment.

Starting from the point where the user has accessed the FSP screen and performed a search.

1. Scroll through the list of checks to locate the claim in question. *Note- Users can take advantage of the Advanced Payment Detail Search link to easily find the claim.

2. Click on All Items to show all claims on the check.

3. Take action on the Paid claim by choosing an Action.

4. Scroll to the bottom of the screen and click SAVE.

5. AlphaFlex will ask for confirmation, click OK.

6. The screen will refresh, the claim will be in que to send the newly updated information. The claim options will be greyed out and the user will not be able to take action on this claim again.

Paid Claims (Detail)

The previous section reviews the process of replacing or reversing a paid claim without any research being done. In the below steps, users will see how to look at the claim details and make the necessary adjustments prior to sending to the payer for reversal or replacement.

Starting from the point where the user has accessed the FSP screen and performed a search.

1. Scroll through the list of checks to locate the claim in question. *Note- Users can take advantage of the Advanced Payment Detail Search link to easily find the claim.

2. Click on All Items to show all claims on the check.

3. Click on the claim number link to open the claim details.

4. Check one of the available options and the fields will unlock.

5. Make any necessary changes, check the Approve box and click SAVE. *Note- In this example the Duration was changed.

6. AlphaFlex will display a confirmation, click the X to close the claim details.

7. The screen will refresh, the claim will be in que to send the newly updated information. The claim options will be greyed out and the user will not be able to take action on this claim again.

*Please Note- As the user is working these claims, hovering over the Action Notes link will show messages to help identify why certain actions are not available to select.

Manual Payment Posting

Under normal usage of AlphaFlex, 835s/RAs will appear without the entity needing to manually input any data. As there might be occasions where the organization inputs a claim through another means (IE- payers portal) users are able to manually add a check details once it is received. This will usually happen when a payment is done outside of AlphaFlex.

Starting from a point where the user has opened the FSP screen.

1. Scroll below the displayed checks and click on Add Check.

2. The user will see a popup screen and will need to provide the payment posting details.

3. Enter in Payer, Check Date, Check Amount, Check #, Check Received Date and any notes.

4. Once complete, search for Billed Items which can be posted to the check.

5. Below the details, input a Date Range, Date Type, Client First and/or Last Name, Client ID and click the SEARCH.

6. Results will appear similar to what is shown below.

7. Locate the billed items that need to be manually posted to the check.

1) Enter in the Paid Amount and then click Save. If something is partially paid, check the Denied Check Box and put in a Denial Reason.

2) Add any Notes as needed.

3) Click SAVE.

8. The check that was created will now show on the Funding Source Payments List.

*Please Note-Payments can also be posted to checks that have been manually created. Just select a check that was created in the above steps. At the bottom of the check, look for Add New Item.

*Please Note- Items can be deleted from the check one at a time using the Delete button. If all items need to be removed, select the Void Check button at the bottom.

Items removed are moved back into unapplied status.

Correcting Checks/AR RecordsAlphaFlex gives the user the ability to correct the payer on a check. This will assist when a rebill is done and will greatly help the process to avoid any lingering denials.

To correct a Payer:

1. Open the Funding Source Payments submodule.

2. Search for the check using a combination of any of the below filters.

3. Once the check appears, take note of the Payer. If the check has not been voided and is an 835 check, there will be an EDIT link.

4. Click EDIT and the following modal will appear.

5. Select the correct payer from the dropdown.

6. After the new payer is displayed in the field, click SAVE.

*Based on the payer selected, AlphaFlex will look up the correct benefit plan for the client(s) on the check. If the system finds more than one benefit plan for the client(s), the process will stop and return to the above screen.

*If the system does not find a benefit plan for the client(s), the process will stop and return to the above screen.

*If the system finds either of the above 2 conditions, the model will reload with the claims that fell into one of those conditions. The user will need to pick the correct benefit plan to assign this check detail. Keep in mind, this benefit plan DOES NOT have to be one assigned to the client(s).

*After choosing the benefit plan, click SAVE again and AlphaFlex will correct the payment received record.

Once the above steps are complete, AlphaFlex creates AR records to correct previous actions.

*In the case below the record generated from the 835 that was incorrectly assigned was the denied amount of $48.66. This record was then moved from this Benefit Plan. Because of other actions taken on this Benefit Plan this left an overage on the denial amount thus leaving a pending balance so the system auto adjusts this amount so the balance will be zero.

*The incorrect records were moved to this Benefit Plan. Since there wasnt a previous invoice for this Benefit Plan, one is created. The $48.66 denial was moved as well. The previous payments were added and since this claim had already been rebilled to a third Benefit Plan, it was zeroed out by adding the rebill adjustment for the remainder.

*Also, since this claim had already been rebilled to a third Benefit Plan, it was not

changed.

To correct a Benefit Plan:

1. Open the Funding Source Payments submodule.

2. Search for the check using a combination of any of the below filters.

3. Once the check appears, take note of the Payer.

*Note - If the check has not been voided and there is an 835 check, there will be an EDIT link.

4. Click on EDIT to update the Payer.

5. The screen will refresh and a Choose Payer window will appear.

6. Choose a Payer from the dropdown list.

7. Click SAVE to store the update.

8. The screen will again refresh and the list of claims on the check will appear.

9. Choose a Benefit Plan for each claim/client from the values in the dropdown.

10. Click SAVE to store the changes.

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