Medisoft sends a patient statement before insurance pays because, by default, it treats the patient as responsible for a charge. Charges go to insurance first only when the Assignment of Benefits box, the setting that tells Medisoft insurance is responsible, is checked on the patient’s case when the charges are saved.
If the box was unchecked, or the insurance was added after the charges were entered, the balance stays with the patient and lands on a statement. Checking the box and clicking Update All moves it back to insurance.
This is one of the most common calls our support team gets, and it’s usually a setting, not a software error. The video below shows the fix start to finish. The steps, and how to prevent it, are written out underneath.
How do I know if it’s a setup mistake, a denial, or a deductible?
A patient statement before insurance pays isn’t always a setup mistake. It can also come from a denial or a deductible. Each looks different on the charge, so check before you change anything.
- From your list of statements, double-click the statement and open the Transaction tab. This shows the charges going out on that statement.
- Compare the charge amount to the remainder amount. If they match, insurance hasn’t paid or adjusted anything on that charge.
- Open the patient’s transaction screen and add two columns: Primary Responsibility and Statement Number. Click the small black dot in the top-left corner to add columns.
- Look at those charges. Is Primary Responsibility “False”? Is the claim number blank?
- If only part of the charge remains, then insurance has already adjusted the rest, so the balance is likely a deductible.
- If the charge has a claim number but hasn’t been paid, check that claim for a denial.
- If the remainder equals the full charge, Primary Responsibility says False, and there’s no claim number, you’re looking at a setup mistake. No claim was created because Medisoft treated the patient as responsible.
Two things cause this most often:
- The Assignment of Benefits box is unchecked on the policy tab.
- The charges were entered before the insurance was set up.
What does the Assignment of Benefits box do in Medisoft?
It tells Medisoft that insurance is the first party responsible for the balance. With the box unchecked, the balance goes to the patient automatically.
Why do prior charges not get the new insurance details?
If charges are entered before the insurance is set up, Medisoft reads that as the patient having “no insurance at the time of the visit.” So, when you add insurance later, only the charges entered afterward will go to insurance, while the earlier ones stay with the patient.
How do I fix it?
- Open the patient’s case and go to the Policy 1 tab.
- If the insurance wasn’t on the case when the charges were entered, make sure it’s entered here now.
- Check the Assignment of Benefits box.Important note: When you check the box, Medisoft will warn you that the change only affects new transactions. You don’t need to delete or re-enter any charges for this to go into effect for previous charges. Update All, in step 5, applies the change to them.
- Save the case.
- Click Update All in the bottom-left corner of the case screen.What does Update All do? Update All re-reads the case and applies it to the charges already entered. If the insurance was added after the charges were created, those older charges still show the patient as responsible. Update All finds the insurance and the checked Assignment of Benefits box, then moves the existing balance from the patient to the primary insurance.
- Check the Patient tab. The balance that was listed under the patient should now be $0. In our webinar demo, a $266 patient balance went to $0. The insurance tab showed it now as TNB (total not billed), which means insurance owes it and hasn’t been billed yet.
- Create the claim and send it, so insurance pays first.
- If a statement was already created for those charges prior, delete it from your statement list. The old statement showed the patient responsible for everything. Once insurance pays, a new statement will show the correct remainder.
How do I default my insurance as the responsible on new patients?
In Medisoft Advanced and Net Pro, you can set the box to check itself on every new case.
- Open a brand-new, empty case. Don’t use an existing patient’s case.
- Check Assignment of Benefits, plus any provider or facility codes you always use.
- Click Set Default Settings.
Setting defaults from an existing case will copy that patient’s policy number onto every new patient, so always start from an empty one.
Check Your Setup Before You Blame the Software
A statement that goes out before insurance pays can look like a software error or a denied claim, and that’s an easy conclusion to jump to. Before you do, check the remainder, the Primary Responsibility column, and the claim number. Knowing how to read them, and how to correct a setup issue when that’s the cause, keeps your billing running smoother and keeps patients from getting statements they shouldn’t.
For more support, or to request a Medisoft setup review, visit our Medisoft support page. You can also find more Medisoft step-by-step walkthroughs on our YouTube. AZCOMP has been in business since 2000 and has been named CompuGroup Medical’s #1 Medisoft reseller every year since 2005. Our U.S.-based support team helps practices with questions like this every day.
