Settling with the insurance company

Once you submit insurance claims to the insurance company, they will review and process them according to their policy. When the insurance company sends payment, you need to record that payment in Usystems and reconcile it against the claims you submitted.

Before you start

• Insurance claims must have been created and submitted to the insurance company (see "Billing a patient with insurance coverage").
• You must have received a remittance advice or explanation of benefits (EOB) from the insurance company showing what they approved and paid.
• You need permission to record payments and create journal entries (typically: accounting staff or administrator).
• Have the payment details: amount, date received, check number or bank transfer reference, and which invoices the payment covers.

Steps

1. Go to Payments. Open in Usystems

2. Click New Payment or Record Payment.

3. Select Insurance Company as the payer (not a patient).

4. Enter the date the payment was received.

5. Enter the amount paid by the insurance company.

6. Enter the reference number (check number, bank transfer ID, or remittance advice number).

7. In the details section, link the payment to the specific invoices it covers. The system will automatically calculate:

   • Which invoices are fully paid by this insurance payment
   • Which invoices still have a balance due from the patient

8. Review the reconciliation summary to confirm that the payment matches what the insurance company stated in their remittance advice.

9. Save the payment record.

10. If the insurance company paid less than expected (partial payment or rejection), update the patient's invoice to reflect the unpaid balance and communicate with the patient about what they owe.

Accounting impact

• Insurance payments are recorded as a credit to the Insurance Receivable account (reducing the amount the insurance company owes you).
• Unpaid amounts remain as receivable and are transferred to the patient's account if the insurance company denied or partially paid the claim.
• Adjustments (e.g., denied charges) may need to be written off or credited back to the patient depending on your clinic's policy.

Tips & common mistakes

• Always match the payment to the original claim: use the remittance advice to confirm which invoices are covered by each payment.
• Follow up on denied or reduced payments: if the insurance company denies a charge, contact them to understand why and determine whether to resubmit or bill the patient.
• Don't assume the patient won't pay: even after insurance pays their portion, the patient still owes their copay, deductible, or coinsurance. Send a separate bill to the patient for their balance.
• Keep records of all correspondence: store remittance advices and explanations of benefits for at least 3 years for audits and dispute resolution.
• Reconcile regularly: compare the invoices you sent to the insurance company with their payments and rejections at least monthly to catch errors early.