Liu Huang was seen for an outpatient visit at the Central Clinic and received a glenohumeral joint injection during the appointment. A claim was created for this visit and procedure and submitted to Liu's insurance company. The insurance company provided Central Clinic with the below Remittance Advice (known as an Explanation of Benefits (EOB) when provided to patients), indicating what they covered, and they also submitted payment for their share through Electronic Fund Transfer (EFT). Review the submitted claim under the Account section of Liu's chart. Then update the ledger to indicate the insurance adjustments and payments.
Additional info:
Liu has met his annual deductible. Any Provider Charges that exceed the insurance company's Allowed Charges were discounted and adjusted by the insurance company – neither the insurance company nor the patient will be responsible for any amount exceeding the Allowed Charges in this situation, and the provider will not receive payment for this amount. The insurance company then pays 80% of the Allowed Charges, and the remaining 20% is Liu's responsibility as coinsurance.
Enter Provider Responsibility amounts as adjustment transactions from the insurance company as a credit without a balance transfer. Enter Paid Amounts as payer payments via EFT.