Electronic Claims Reconciliation functions are used to track payment of, and report on, claims for third party and Medicaid prescriptions. Payment information, details from primary, secondary and tertiary third parties, is recorded on the Transaction Record.
After claims have been paid by the third party or Medicaid, an 835 File is sent to your system. Contact your third party or Medicaid to request the 835 file, and to determine the method by which the file will be sent to you. Claims are typically paid by direct deposit or check and may or may not come with a paper/electronic report of the payment details. The 835 File provides these details.
After remittance is received from the third party or Medicaid, payments must be posted. There are two options for posting payments: manual or auto post.
There are three reports to provide information about claim payments. The Reconciliation Report prints claims that have a billed date. The Status Report is an overview of selected claims and their status. The Third Party Aged Receivables Report lists claims not yet paid.
Transaction Record Reconciliation Information
Third Party Aged Receivables Report