EOP Summary - Enter Payment

Once an EOP has been created in TFM, the next step is to record the procedure payments that comprise the EOP. Selecting the Enter New Payment button in the EOP Summary dialog will cause the following dialog to display.

The Enter Procedure Payment dialog contains reference information across the top that indicates the payer and the amount of the EOP payment. In the example, you will notice that Aetna is the payer and no payment information has been entered yet. The dialog fields in this screen are used to record the payment information.

On the left side of the dialog are the fields used to capture the payment details and the fields on the right side are used to capture the financial details of the payment. Each of the field are explained below:

Payment Details

• Patient - select the patient associated with this procedure. You will notice that this field is gray indicating the field isn't editable. This is because only patients that are recorded in TFM can receive payments. TFM allows you to select the patient from a table of patients by selecting the Set button. The table will contain only the patients that have coverage from the current payer.
• Encounter Date - this popup field can be selected once the patient has been selected above. There could be multiple encounters for this patient. Only dates for unbalanced encounters will be selectable.
• Claim - this popup field can be selected once an Encounter Date has been selected. TFM will automatically select a claim if there is only one choice.
• Insurance - this non-editable field is the name of the insurance where the claim was made.
• Insurance Level - this non-editable field is the level of coverage provided by this insurance to the patient. Possible values are Primary, Secondary and Tertiary.
• Insurance Claim# - when the payer receives a claim from a provider they may assign their own claim number to this transaction. This field is provided to capture this number for future reference.
• Procedure - this is a popup list of procedures that occurred during the specified Encounter.

Payment Values

• Charge - the practice's stated charge for the procedure
• Quantity - the number of times the procedure code was charged
• Total - Quantity multiplied by the Charge.
• Adjustment - payer designated adjustment to the Charge
• Allowed - the payer designated amount allowed to Charge for this procedure.
  (Allowed = Charge - Adjustment)
• Co-Insurance - the amount paid by another payer
• Co-Pay - the amount the payer indicates the patient owes to satisfy their contract
• Deductible - the amount the payer indicates the patient owes to satisfy their contract deductible
• Withhold - payer designated withhold
• PAID - the amount paid for this procedure by the payer.
  ( PAID = Allowed - Withhold - Deductible - Co-Insurance - co-pay)

User Interactions

There are several buttons along the bottom of the dialog that control the information storage. These buttons do the following:

• Cancel - ignore all entered data and close the dialog
• Save - save all the data in the payment fields in the TFM database. This keeps the dialog visible allowing you to select another procedure or another claim or another encounter or another patient that might also be paid for on this EOP. This is provided because there can be many procedures paid on an EOP and it keeps you having to repeatedly open and close this dialog.
• Finished - save all the data in the payment fields in the TFM database then close the dialog.