AR Transaction Mapping

In order for accounts receivable (AR) data to be correctly entered in Contract Manager, the AR transaction codes (those that are used for payments, adjustments, write-offs, comments and other information) are assigned or “mapped” to a category that tells FinThrive how the transaction affects the account. Mapping the transactions is vitally important to determine underpayments based on the variances generated. These variances are created from comparing actual transactions to FinThrive calculated reimbursement.

An AR system records many different types of transactions, and each is coded very specifically as to the type of transaction. Contract Manager captures the following transactions: insurance payment, patient payment, primary insurance adjustment, other contractual write-offs, non-contractual/other adjustments, and those not used in calculations. These six categories work in specific calculations to generate discount and / or payment variances in order for you to monitor underpayments. Transactions entered for charity adjustment, bad debt write-off, comments, transfers, etc., may or may not be recorded in Contract Manager, depending on your preference. However, it is critical that these transactions are correctly categorized so that they are not mapped as an insurance payment or insurance adjustment, which creates false variances on your accounts. For example, if your AR transaction code INSADJ (primary insurance adjustment) is mapped as non-contractual/other adjustment, the calculated discount variance on the account will not be accurate.

As part of the implementation process, the account representative requests AR transaction codes and creates the mapping scheme. Occasionally, a code can be added to the AR system that does not get mapped in Contract Manager. These transactions display the message “Unmapped txn (added by pmt post).” When an unidentifiable code comes across the data transfer, it must be promptly mapped in order for reprice results to calculate correctly. Please contact your Account Representative as soon as you identify and correctly categorize an “NM” transaction. Your Account Representative will map the transaction and run an update on all affected transactions in Contract Manager.

Listed below are the general calculations used in FinThrive.

  • Payment variance–takes the difference in the Contract Manager expected payment versus the sum of insurance payments and patient payments.
    • Expected payment - (Insurance payments + Patient payments) = Payment variance.
  • Discount variance–takes the difference in the FinThrive expected discount versus the sum of actual discounts and other contractual write-offs.
    • Expected discount - (actual discount + other contractual write-offs) = Discount variance
  • Non-Contractual/Other Adjustments–this category is not utilized in either the payment or discount variances. It is only used to reduce the balance of the account. Secondary adjustments should be mapped to this category so that they do not affect the discount variance.
  • Not used in calculation–when transactions are mapped to this category, there is no affect on the account, either in balance reduction, payment or discount variances. Non-mapped transactions also work in this way until they are mapped.

Each transaction code in a clinic’s AR system must be matched to one of the categories in Contract Manager in order to calculate correctly. The categories are:

  • Actual Discount (Insurance)–All primary insurance adjustments.
  • Other Contractual Write-offs–Denials.
  • Non-Contractual / Other Adjustments–Secondary insurance adjustments, small balance write-offs, administrative adjustments, bad debt, etc.
  • Insurance Payment–All insurance payments.
  • Patient Payment–All patient payments.
  • Not used in calculation–comments, bad debt, transfers, etc.

The patient account reprice summary found in Contract Manager appears with these categories as well as charges and calculations.

To map your transaction codes to Contract Manager, your account representative requests a list of all your transaction codes and places them into a Microsoft Excel® worksheet. The worksheet is then returned to you to discuss and decide how to categorized each code. The process is simplified since you need only select one of the categories from the list.