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Portions that appear to be incorrect should be addressed as soon as possible. This will ensure that financial reports and statements are correct. If you determine that any of your insurance and patient portion breakdowns are incorrect, this guide will help you troubleshoot to determine where the source of the issue is. Troubleshooting issues with incorrect portions usually involves checking the insurance claim status.

You may use this tool to quickly troubleshoot Portions. More detailed explanations are included below.

Using The Prior Authorization:

If there is too large of a patient portion:

• Check to be sure that all procedures in question have an insurance claim created for them, or that they appear on all claims. A quick way to determine this is done by highlighting the claim and seeing what is tied to it, by either using the View Options menu (located in the upper right corner of the MacPractice ledger) and selecting Related Transactions or by simply visually checking what is tied with the yellow highlights. If you printed a paper claim form and saved the pdf to the database, you can also check the pdf copy to verify which procedures were printed on the claim. For electronic claims you can do something similar by double clicking on the claim in the ledger, then in the bottom left area in the eClaims ability, expand the Procedures node to determine which codes are associated to the claim. If you find that a procedure was indeed missing from a claim, you will need to create a new claim for the procedure in question, or delete the original claim and start over, provided the claim hasn't been sent yet.

• Check if the charge has a copay amount associated to it in the Charge window. If the Charge Copay checkbox is checked, any amount entered in the Patient > Insurance > Copay area will be associated to the charge as a copay amount. This copay amount will always stay in the patient portion until it is paid, regardless of claim status. The copay amount can be overridden in the Charge window, if needed.

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• Check either Carrier Always Pays Provider or Accepts Assignment in the Insurance reference. Generally speaking, if you do not accept assignment with an insurance carrier MacPractice assumes the insurance payment for the procedure will go to the patient, and your office will collect payment from the patient. Because of this, if Accepts Assignment was not checked when the claim was created, the portion will remain in the patient portion. If Accepts Assignment needs to be checked, you will need to recreate your claim. If you do not accept assignment with a carrier, but you do collect payment from them, or wish the portion to move to the insurance portion, check Carrier Always Pays Provider instead. This will ensure the portion will move to the insurance portion when a claim is created, without having to have an "accepts assignment" status printed or sent on your claims.

If there is too large of an insurance portion:

• Check for outstanding claims that should not be open. You can quickly check for incorrectly open claims easily by using the View Options menu and selecting Outstanding Claims. This will display only open claims in your patient's incident. You may also decide to scroll over until you find the Status column in the ledger, at which point you can visually determine where the open claims are. Close all erroneously open claims and check your portions again.

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