Psychological Behavioral Health
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Payments are issued twice a month by ACH, on the 15th and at month end. Deposits usually arrive 1 to 3 business days after they are sent.
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Only the sheets uploaded here. Every figure on this tab comes from one of three files: the appointment status report, the payments export, or a rate sheet below.
Settled claims the payer did not pay at the contracted rate, grouped by payer, code and the exact difference. A group of one is usually that member or that claim. A group that repeats the same difference is usually the schedule.
Every claim a payer still owes, and every session with no claim sent, grouped by how long ago the session was. Mark each one collected, in process, loss, or not charged. A claim leaves this list on its own once an import shows it paid.
Paste the Wells Fargo pay lists for a period and see them against what this tool says each payee was owed. Paste both groups together, individual and business: the headings in the paste tell them apart.
Only needed on the day Claim.MD hands you a file. Everything paid through their API is already stored, so most weeks you skip this step entirely and go straight to Step 2. Loading a file stores what the payer sent. It pays nobody and it builds nothing.
Builds a pay period from every 835 remittance and client payment stored between two dates, whatever brought them in. This is not a view of one file: a period normally covers many cheques from many payers, so the total here is almost never the total of any single file.
These are payment dates, not dates of service. A session seen in September and paid in October belongs to October, because that is when the money arrived.
Staff working area. Providers never see this screen.
Run against the raw file before anything reaches a provider.
Adj is a person deciding something: a lump sum you add on the row, with a reason the provider reads.
Nothing in the file ever creates one.
Open any row to read the full ledger and every claim before you publish.
Add a payment or an adjustment on any row. Every entry records who made it and when.
| Provider | Match | Paid to | Sess | Collected | Gross | Payback1% over $2,500 | Adjadded by hand | Fees | Net |
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Every report PBH has issued this provider, published and staged. Open one to read the ledger and claims, or update it.
Every period PBH has published. Open one to see all providers paid in it.
Internal analysis. Nothing here is visible to providers.
Every published report that carried a payback, totalled by clinician. Filtered on the date the payment was issued, not the dates of service, so a period worked in August but paid in September is included.
Press Run to see what each clinician was paid and has not returned. The Amount to take back now column holds an editable box for each one, filled in with what they still owe. Change any figure you want, then press Add to this period on that row to put it on their payment, or use the button above to add every box at once. Each one lands as a line on the clinician's own row in the pay period you have open on the Payments tab, where you can edit or remove it. Nothing is saved until you publish.