What this is

Most of your payers send their remittances to us electronically through Availity. Throughout the day, the system pulls those electronic remittances in on its own, reads each one, and lines up the payments and adjustments for you to review. Nothing posts to a claim until you approve it, so an electronic remittance can never double up a payment you already entered by hand.

This is different from importing a remittance file, which is for remittances that come back to you as a file you upload yourself.

Opening the remittances queue

Click AR in the menu, then click the Remittances sub-tab. Each row is one payment or adjustment line that arrived from Availity, waiting for your review.

Tabs

  • Pending — your daily work: lines matched to a claim and ready to post.
  • Unmatched — lines where the payer used a claim number the system could not line up on its own. These need a hand before they can post.
  • Matched — lines tied to a claim but not yet posted.
  • Decided — everything you have already approved or dismissed.
  • All — the full list.

Reading the columns

The Match column is the one to watch. A green Matched dot means the line is tied to a claim and is ready to post. A red Unmatched dot means it still needs to be linked. Type tells you whether the line is a payment or an adjustment, and Reference is the check or trace number off the remittance.

Approving a payment

On the Pending tab, open a line's Actions menu and click Approve and post. A window shows the claim, the payer, and the amount, and asks you to confirm. Click Approve and post again. The payment is written to the claim, the line moves to Decided marked Approved, and the claim balance updates in the AR work queue right away.

Dismissing a duplicate

If a remittance is one you already posted by hand, you do not want to post it twice. Open its Actions menu and click Dismiss. Type a short reason, then confirm. The line moves to Decided marked Dismissed, nothing is written to the claim, and your note stays on the record so the next biller knows why.

Matching an unmatched remittance

On the Unmatched tab, open the Actions menu and click Match to claim. A window shows the remittance details and a search box. Type the patient last name or the claim number, and matching claims appear below, already narrowed to the right agency. If you want to read the raw remittance first, click View source ERA file to open it in a new tab. Pick the right claim and click Match to selected claim. The line moves to the Matched tab; open its Actions menu once more and click Approve and post to finish.

Example

Blue Cross sent an $840 payment under their own internal number instead of yours, so it lands on the Unmatched tab. You click Match to claim, search the patient last name, pick the right claim, and click Match to selected claim. Then you open the menu again, click Approve and post, confirm, and the $840 lands on the claim.

Tips

  • Work the Pending tab first — those lines are matched and ready. Clear the Unmatched tab when you have time to track down the right claim.
  • Always leave a reason when you dismiss a line. Six weeks from now it explains why a payment was not posted.