2.2. MARCO TEÓRICO
2.2.9. EL EMPRESARIO Y LA PARTICIPACIÓN EN EL DERECHO PENAL
The Search Payments page enables you to use a range of search criteria to find payments matching your selection.
To search for a payment(s), proceed as follows:
1. Click the Search subtab from the task bar of the Payments tab. The system displays the Search Payments page.
2. In the Search By section, enter/select one or more of the following search criteria:
Note: To clear and redefine your search criteria, click RESET.
Search Criteria
Description
Payer Name
This defaults to "All", i.e., set to find payments made to you by all payers.
To find payments made to you by a specific payer, select the appropriate payer's name from the Payer Name drop-down list.
Search Criteria
Description
Plan Name The name of the payer plan under which the payment(s) has been made.
This defaults to "All", i.e., set to find payments for all plans on which you are registered.
To only find payments for a specific plan, select the appropriate plan from the Plan Name drop-down list.
Payment ID
To retrieve a specific payment, enter the payment's unique identifier, which the system generates for each payment.
Note: Where specified, it is not necessary to enter any other search criteria.
Search Date
You can search for payments based on a particular date by selecting one of the following options from the Search Date drop-down list: Date Received - The date on which Healthcare Link Payer
received the payer's payment instruction.
Payment Date - The payment date on the payment transaction, i.e., the date on which the transaction is due to be paid.
Date Paid - The date on which the payment was paid/cleared. From and
To
Where you have selected a date from the Search Date drop-down list, use the From and/or To fields to specify the date(s).
Examples:
To search for payments with a payment date of October 31, 2008, select "Payment Date" from the Search Date drop-down list, then enter 10/31/2008 (i.e., in MM/DD/YYYY format) in both the From
and To fields (or click the Calendar icon ( ) to select the dates from the pop-ups).
To search for payments with a payment date between October 15, 2008 and October 31, 2008, select "Payment Date" from the
Search Date drop-down list, then enter (or select) 10/15/2008 in the From field and 10/31/2008 in the To field.
To search for payments with a payment date on or later than October 15, 2008, select "Payment Date" from the Search Date
drop-down list, then enter (or select) 10/15/2008 in the From field only.
To search for payments with a payment date on or before October 31, 2008, select "Payment Date" from the Search Date drop-down list, then enter (or select) 10/31/2008 in the To field only.
Search Criteria Description Payment and Amount
You can search for payments with a dollar ($) amount equal to, greater than, or less than a specified amount.
Examples:
To search for payments of $50, select "Equal" from the Payment
drop-down list, then enter 50 in the Amount field.
To search for payments greater than $70, select "Greater than" from the Payment drop-down list, then enter 70 in the Amount
field.
To search for payments less than $90, select "Less than" from the
Payment drop-down list, then enter 90 in the Amount field.
Claim Number
To retrieve payments for a particular claim, enter the unique claim number in the Claim Number field.
3. Once selected, click SEARCH. The system displays the payments matching your search criteria in the Search Result section of the page.
Note: You can click on the column headings to sort the data by that heading in ascending/descending order.
The following table provides information on the displayed fields for the retrieved payments:
Field Name
Description
Reason Only populated for payments that have not passed the validation process, or have been rejected by the payer approver, i.e., Failed or Rejected.
Plan Name The name of the payer plan.
File Name The name of the EDI 835 file containing the payer's claim
payment/advice, which was transmitted to Healthcare Link Payer. Status The status of the payment can be any of the following:
Approved - The payment has been approved, and payment will be made once the payment date is reached.
Rejected - The payment has been rejected.
Invalid - The payment failed validation, e.g., where the provider details didn't match the details received for the payment, the provider was inactive, the payment is a duplicate payment, etc. Awaiting Approval - The payment must be approved before
payment can be made.
Paid - The payment has been made to the provider. Failed - The payment failed file-level validation. Payment
ID
Unique identifier, which the system generates for each payment.
Provider NPI
The National Provider Identification (NPI), which uniquely identifies the provider.
Provider Name
The name of the provider to whom the payment was/is to be made (i.e., your name).
Date Received
The date on which Healthcare Link Payer received the payer's payment instruction.
Payment Date
The date on which the payment is/was due to be paid.
Cleared Date
The date on which the payment was cleared for payment to the provider.
Field Name
Description
Payment Type
The payment type can be one of the following:
ACH (Automated Clearing House) - payment by electronic transfer of funds.
CHK - payment by check.
EOB Type Indicates the method used to submit to you the Explanation of Benefits (EOB) associated with the payment, i.e., electronically or on paper.
Claims Consolidated payments are made from one payer to one of their providers. These consolidated payments comprise of multiple claim payment instruction files, which are aggregated into one payment. The Claims field displays the number of claim payment instructions files, which comprise the consolidated payment.
Payment Amount
The total payment amount in U.S. dollars.
4. Once the payment data is retrieved, the system displays the following additional search criteria filters in the Search By section of the page to allow you to narrow down the search results:
Search Criteria Description Provider Name or NPI
To show payments for a particular provider, enter the name of the provider in the Provider Name field, or use the NPI field to enter the provider's unique NPI (National Provider Identification).
Status By default, the system retrieves payments regardless of their status (i.e., retrieves all statuses). However, you can search for payments with a particular status by selecting one of the following options from the Status drop-down list:
Approved - The payment has been approved, and payment will be made once the payment date is reached.
Awaiting Approval - The payment must be approved before payment can be made.
5. Once selected, click SEARCH. The system refreshes the page, and displays the payments matching your search criteria in the Search Result section of the page (see previous).
Note: To clear and redefine your search criteria, click RESET.
6. From the retrieved payments in the Search Result section of the page, you can: