Receipt Posting Automation Logic

For every new receipt that is added to the system, iSalus will process that receipt using our custom Receipt Posting Automation algorithm. This process will take place as soon as the receipt is generated and on a nightly basis.

Co-Pay Receipts

If a receipt is created with a type of 'Co-Pay', the following logic will be followed:

  • If the receipt is associated with an appointment... 
    • Check to see if a claim exists for that appointment… 
      • If so, associate the payment with this claim based on the Procedure Code Copay Indicator and the Receipt Disbursement company settings.
      • If not, check to see if only 1 claim exists where the receipt date and claim service date are the same.
        • If only 1 claim exists, associate payment with this claim based on the Procedure Code Copay Indicator and the Receipt Disbursement company setting.
        • If more than 1 claim exists, set the status of the receipt to Error.  
        • If no claims exist, check the Receipt Co-Pay Hold Days company setting to see if receipt date is less than the parameter. 
          • If so, the receipt status will be set to 'Hold'.
          • If not, the receipt status will be set to ‘Error’

NOTE:  A Co-Pay amount will only be applied to one procedure on a claim until that procedure’s balance becomes 0.  After that, the remaining balance is treated as a General Payment and will follow the logic below.   However, if you would not like the remaining balance to be treated as a General payment, you can modify the company setting to only apply the amount to the first procedure that has the Procedure Code Copay Indicator flag set.

Coinsurance and Deductible Receipts

If the receipt is created with a type of 'Coinsurance' or 'Deductible', the following logic will be followed:

  • If the receipt is associated with an appointment... 
    • Check to see if a claim exists for that appointment… 
      • If so, associate the payment with this claim.
      • If not, check to see if only 1 claim exists where the receipt date and claim service date are the same.
        • If only 1 claim exists, associate payment with this claim.
        • If more than 1 claim exists, set the status of the receipt to Error.  
        • If no claims exist, check the Receipt Co-Pay Hold Days company setting to see if receipt date is less than the parameter. 
          • If so, the receipt status will be set to 'Hold'.
          • If not, the receipt status will be set to ‘Error’

General Payment Receipts

If a receipt is created with a type not equal to 'Co-Pay', the following logic will be followed:

  • Find a list of claims where the Level = 'Statement'', or where the Status is in any of the 'Statement' options, or a 'Claim Invoice Date' has been set.
  • Exclude any claims where the Claim Status has the Skip auto-association of patient payments indicator set.
    • If patient outstanding balance is greater than or equal to the receipt balance 
      • Apply payments to these claims based on the Receipt Disbursement company setting
    • If the outstanding patient balance is less than the receipt balance 
      • Apply payments to claims in a way the patient balance would become $0 based on the Receipt Disbursement company setting. For the remaining receipt balance, check to see if the Credit Receipt Hold Days has passed 
        • If it has not, the receipt status should be set to 'Hold'
        • If it has, apply the remaining balance to the most recent claim for the patient and set the claim status to the value in the company setting: Credit Receipt Claim Status 
          • If no claim exists, set receipt status to 'Error'

Pre-Pay Payment Receipts

If a receipt is created with a payment type that is set to ‘Pre-Pay’.  Because these payments are classified as pre-pay, iSalus will not be able to automatically post the receipt, because we will not know which claim to post it to (as the claim is likely to be created several days or weeks in the future).  Because of this, all ‘Pre-Pay’ payments will be immediately set to “Error” after the Credit Receipt Hold Days setting has been met.

Note:  To designate a Payment Type as “Pre-pay”, you can do this here:  Setup > Payers > Gear Icon > Setup > Payment Types.   Select one of the payment types where ‘Receipt Type’ = Y.  Then, on the setting page, choose ‘Prepayment’. Save.