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When Insights receives a remittance, the patient responsibility (PR) it specifies is often different from what the patient paid at the time of service. This guide explains how payments and PR are reconciled.

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Part 1: In-Office

When a patient makes a payment in your office, two things are recorded on their profile:
  • The patient’s payment is recorded.
  • Insights records Estimated Patient Responsibility based on the amount paid — a placeholder meant to be replaced by finalized PR once a remittance arrives.
Estimated PR is created in the exact amount and type of the payment to balance the account. For example, a $20 copay records:
  • $20 Payment of type “Copay”
  • $20 Estimated PR of type “Copay”
This keeps the patient’s balance unaffected by the payment, holding those funds until a remittance is received for the claim.

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Part 2: Post-Remittance

Once the payer sends a remittance, Insights updates the total PR:
  • The PR for that date of service is updated to the amount in the remittance.
  • The PR type changes from Estimated PR to Post-Remittance PR.
  • The new PR is compared against what was paid:
    • Payment equals PR — no further action.
    • Payment less than PR — the difference is added to the patient’s balance and included on their next statement.
    • Payment greater than PR — the overpayment becomes a credit on the patient’s account.
Overpayment credits are locked to the appointment’s date of service by default and won’t automatically apply to balances for other dates of service, but your staff (or the patient) can apply them manually.

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In Conclusion

Up-front collection will never perfectly match the payer’s final decision. For the difference, Insights automatically takes the appropriate follow-up — adding a balance or issuing a credit — so your staff can focus on patients.