Insurance Back End

You may click on the graphic above to get a visual representation of how clinic services are paid by Third Party Payers.

• First, Encounters are created. They are made up of previously unbilled charges for a stated time period that are specific to a particular client and Third Party Payer.
• Claim Batches are a group of selected Encounters.
• Claim Batches are sent to a Clearinghouse. The Clearinghouse will validate claims and charges, and forward them on to each individual Third Party Payer.
• The Third Party Payer sends an ERA or Electronic Remittance Advice to the clinic explaining which charges will be covered and listing the amounts covered.
• The Third Party Payer remits the payments back to the clinic directly.
• The Third Party Payer generates an ERA (835) and sends it back to the Clearinghouse.
• Last, the Clearinghouse forwards the ERA (835) back to SAMMS and the information is entered into the system.

• Encounter Creation
• Third Party Encounter Detail Screen
• Creating Claims
• The Claims Screen
• Accounts Receivable – A/R
• Processing a Payment in A/R
• Third Party A/R Posting Definitions
• Batch Types
• Insurance Action Queue