Payment Posting Guide

Kareo Desktop Application (PM)

Updated: March 2023

Introduction
Kareo Billing subscribers have access to both the Kareo Desktop Application (PM) and the Billing module in the
Kareo Web Platform. The Payment Posting Guide will go over how the Payments feature of the Kareo Desktop
Application (PM) enables you to easily enter, apply, and manage payments. This guide is designed to provide
instructions for all user types. To complete your designated task(s), use the Table of Contents to navigate to
the respective section(s) of the guide for instructions. If you don't have access to a specific task or function
described within the payment topics of this guide, please contact the person in your office who is a
System Administrator for Kareo.

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Table of Contents
Payment Posting ............................................................................................................................................................................................ 5

Manual Payment Posting ......................................................................................................................................................................... 5

Enter General Payment Information ................................................................................................................................................. 5
Apply Payment....................................................................................................................................................................................... 11

Automatic Payment Posting.................................................................................................................................................................. 19

Post Electronic Remittance Advice (ERA) Payment .................................................................................................................... 19

Additional Payment Posting Scenarios ................................................................................................................................................. 24

Payment Reversals ................................................................................................................................................................................... 24

Reverse Patient Payment ................................................................................................................................................................... 24
Reverse Insurance Payment .............................................................................................................................................................. 27

Payment Refunds ..................................................................................................................................................................................... 31

New Single Payment Refund ............................................................................................................................................................. 31
New Multiple Payment Refund ......................................................................................................................................................... 33

Insurance Denials ..................................................................................................................................................................................... 35

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 Manually Post Claim Denial ............................................................................................................................................................... 35

Adjustments ............................................................................................................................................................................................... 39
Post Adjustment on Payment Record ............................................................................................................................................ 39
Post Adjustment on Claim Record................................................................................................................................................... 41

Learn More ...................................................................................................................................................................................................... 44

Help Center ................................................................................................................................................................................................. 44

Kareo University ........................................................................................................................................................................................ 44

Guides .......................................................................................................................................................................................................... 44

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Payment Posting
The Payments feature of Kareo enables you to easily enter, apply, and manage payments. Once patient, insurance, and other Payment
records are created, you can view the complete log of all financial transactions to find, edit, or delete the payments when necessary. For
more information about how to find, edit, and delete payments, review the Payment Records help article.
There are two ways to post payments:
• Manual Payment Posting: Payments received in person or by mail from patients (e.g., cash, card payments, electronic
checks), insurance companies (e.g., paper provider remittance advices) and other payers are posted manually.
• Automatic Payment Posting: Payments received electronically and reported in an Electronic Remittance Advice (ERA) can be posted
automatically.

Manual Payment Posting

Payments received in person or by mail from patients (e.g., cash, card payments, electronic checks), insurance companies (e.g., paper
provider remittance advices) and other payers are posted manually. There are essentially two steps to manual payment posting. First, the
general information about the payment is entered. Then, the appropriate amounts of the payment are applied to the corresponding service
lines.

Enter General Payment Information

The first step to manually post a payment is to enter the information about the payment under the General tab of the Payment record. The
following sections provide the available workflows for entering the general information for payments received from patients, insurances, and
other payers.

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Enter Payment from Patient
You can easily record or swipe a card to enter patient payments for copays and outstanding patient balances. There are several ways to
create a new Payment record and the best workflow(s) for your practice depends on the practice’s processes and enabled features.
• To create a new Payment record via the patient’s record or appointment, review the Collect Patient Payment help article.
Note: This recommended workflow displays the patient’s balance for review, has the option to save or use a credit card on file,
and not only print a payment receipt but email it as well.
• For Kareo Patient Collect (KPC) powered by Stripe enabled customers, review the KPC Powered by Stripe: Collect Patient Payment
help article.
• To directly create a Payment record for the patient payment, review the Enter Payment from Insurance, Other Payer, or Patient
section.
• To create a Payment record by entering the patient payment information on a new encounter, review the New Encounter Patient
Payment section of the Enter Patient Payment help article.

Enter Payment from Insurance

• To create Payment records for payments received in person or by mail (e.g., paper provider remittance advices) from insurance
companies, review the Enter Payment from Insurance, Other Payer, or Patient section.
Note: When manually posting primary insurance payments, ensure all applicable payment information is entered and correct to
prevent secondary electronic claim rejections for transferred balances.

Enter Payment from Other Payer

• To create a Payment record for payments received from other payers (e.g., attorney, employer), review the Enter Payment from
Insurance, Other Payer, or Patient section.

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Enter Payment from Insurance, Other Payer, or Patient

1. On the top menu bar, click Encounters > Find Payments. The
Find Payment window opens.
Tip: For faster navigation, press F10 on your keyboard.

2. To prevent duplication, verify the payment is not in the system.

Then, click New. The New Payment window opens.
Note: To ensure the payment is not already in the system,
select the All tab and click to deselect "Show unapplied only"
when searching for the record. For more information about how
to find a Payment record, review the Find Payment section of the
Payment Records help article.

3. Batch #: If applicable, enter a batch number for the payment.

Tip: Batch numbers are helpful for running reports when
there is a consistent naming convention such as the posting
date with the user's initials (e.g., MMDDYYYYAB). Then, when
running a report (e.g., Payments Detail), customize and filter by
that specific batch number.

4. Post Date: Defaults to the current date. If necessary, enter a

different posting date for the payment.

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Enter Payment from Insurance, Other Payer, or Patient, cont.

5. Type: Select one of the following types of payment received

(e.g., Insurance, Other, Patient). Additional options display
depending on the selected type.
• Insurance: Selected by default. To create a new record for a
payment received from the insurance company, keep
Insurance selected. Then, click Insurance to search and
select the appropriate payer and enter the Adjudication
Date.
Note: The adjudication date is provided on the paper
remittance advice (RA) which indicates the date the payer
processed the claim(s).

• Other: To create a new record for a payment received from

another source (e.g., attorney, employer), click the drop-
down arrow and select Other. Then, enter the Other source
of payment.
▪ If applicable, click Appointment to search and select
the appropriate patient appointment related to the
payment.

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Enter Payment from Insurance, Other Payer, or Patient, cont.

• Patient: To create a new record for a payment received

from a patient, click the drop-down arrow and select
Patient. Then, click Patient to search and select the
appropriate patient.
▪ If applicable, click Appointment to search and select
the appropriate patient appointment related to the
payment.

6. Category: If the practice uses categories for certain payment

reports, click the drop-down arrow and select the appropriate
category. For more information about categories, review the
Categories help article.

7. Method: Click the drop-down arrow to select how the payment

is being made.

8. Reference #: If applicable, enter the reference number for the

payment (e.g., check number, authorization number).

9. Amount: Enter the total amount of the payment.

10. Notes: Enter any internal notes related to the payment.

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Enter Payment from Insurance, Other Payer, or Patient, cont.

11. When finished, click Apply Now and refer to the Apply Payment
section to apply the payment.
• To save the Payment record without applying the payment,
click Save. A confirmation pop-up appears then click Yes to
continue without applying the payment. When ready to
apply the payment, refer to the Apply Payment section.
• To save and print a receipt for a patient’s Payment record
without applying the payment, click Save & Print Receipt.
A confirmation pop-up appears, click Yes to continue
without applying the payment then print the receipt using
the computer’s print function. When ready to apply the
payment, refer to the Apply Payment section.

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Apply Payment
The second step to manually post a payment is to apply the appropriate amount(s) of the payment to the corresponding service line(s). The
following sections provide instructions for applying patient, insurance, and other payments.

Apply Payment from Patient or Other Payer

Once the General tab information for a payment from the patient or other payer is entered, follow the steps below to manually apply the
payment amount(s) to the corresponding service line(s).

1. On the Apply tab of the payment, use the top options to add a
patient or an encounter. If necessary, select the Apply tab or
click Apply Now and the Apply tab opens.
• If the payment is not currently open, find the payment then
double click to open it. For more information about how to
find a Payment record, review the Find Payment section of
the Payment Records help article.
• If the payment has not yet been entered, refer to the Enter
Payment from Patient section for patient payments, or the
Enter Payment from Other Payer section for other
payments.

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Apply Payment from Patient or Other Payer, cont.
2. Add Patient: Selected by default. To add service lines by
encounter ID instead, click the drop-down arrow and select
Add Encounter.
Note: For patient payments, the Patient entered on the
General tab is automatically added and all open service lines
associated with the patient are listed. When an encounter is
added, all service lines associated with the encounter will be
listed.

3. If necessary, enter the patient’s name or encounter ID. Then,

press Enter on the keyboard. The service lines are listed.
Tip: When adding an encounter, enter the encounter ID + Z
(e.g., 176Z) to quickly add the appropriate record and avoid
having to search and select it.
• If the Find Patient or Select Encounter window opens, search
and select the appropriate record.

4. Show Only: Defaults to Selected. If necessary, click the drop-

down arrow to select to list All, Open, Settled, or Negative
Balances service lines.

5. Click to select the patient and/or service line the payment

amount needs to be applied to.

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Apply Payment from Patient or Other Payer, cont.
6. Paid: Enter the amount of the payment to apply to the selected
service line.

7. Status: If there is a remaining balance after the payment

amount is applied, click the drop-down arrow to select the
appropriate status update. Then, enter a reason code if
applicable.

8. Note: Enter any internal notes related to the payment amount

applied that will display when viewing transaction line details
on the corresponding Claim record.

9. Verify the posted transaction line(s) on the right side of the

window are correct.
Note: The transaction line(s) in bold are posted under the
Transactions section of the corresponding Claim record once
the payment is saved.

10. To continue applying amounts of the payment, click Next Line if

the amount should be applied to the next service line listed, or
click to select the appropriate service line. Then, repeat steps 6-
10 as necessary.

11. When finished applying the appropriate payment amount(s) to

the corresponding service line(s), click Save.

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Apply Payment from Insurance
Once the General tab information for a payment from the insurance company is entered, follow the steps below to manually apply the
appropriate amounts of the payment to the corresponding service lines as reported on a paper provider remittance advice (RA) (e.g.,
explanation of payment, standard paper remittance) or the patient explanation of benefits (EOB).

Apply Payment from Paper Remittance Advice (RA)

1. On the Apply tab of the payment, use the top options to add an
encounter or a patient. If necessary, select the Apply tab or click
Apply Now and the Apply tab opens.
• If the payment is not currently open, find the payment then
double click to open it. For more information about how to
find a Payment record, review the Find Payment section of
the Payment Records help article.
• If the payment has not yet been entered, refer to the Enter
Payment from Insurance section.

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Apply Payment from Paper RA, cont.
2. Add Encounter: Selected by default. To add service lines by
patient, click the drop-down arrow and select Add Patient.
Note: When an encounter is added, all service lines
associated with the encounter are listed. When a patient is
added, all open service lines associated with the patient are
listed.

3. Enter the encounter ID or patient’s name. Then, press Enter on

the keyboard. The service lines are listed.
Note: The encounter ID may be indicated as the Patient
Account Number or Claim Reference ID on the paper RA as
follows Encounter ID + Z + Kareo ID (e.g., 176Z15050).
Tip: Enter the encounter ID + Z (e.g., 176Z) to quickly add the
appropriate record and avoid having to search and select it.
• If the Select Encounter or Find Patient window opens, search
and select the appropriate record.

4. Show Only: Defaults to Selected. If necessary, click the drop-

down arrow to select to list All, Open, Settled, or Negative
Balances service lines.

5. Click to select the patient, encounter, and/or service line the

payment amount needs to be applied to.

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Apply Payment from Paper RA, cont.
6. Payer: The payer auto-populates from the Insurance entered on
the General tab of the payment.

7. Allowed: Enter the reported allowed amount. If the claim was

denied, leave as $0.00.

8. Contract Adj: Automatically calculates when using Tab on the

keyboard to advance to the next field. If necessary, enter a
different amount. Then, select the appropriate adjustment
code.
Note: The codes available for selection pull from the
Adjustment Codes list. For more information, review
the Adjustment Codes help article. If a Default Adjustment is
entered on the Insurance Company General Settings for the
payer, that adjustment code auto-populates. For more details
about insurance company settings, review the Insurance
Company General Settings help article.

9. Second Adj: If applicable, enter the reported second adjustment

amount and adjustment code.

10. Paid: Enter the amount of the payment to apply to the selected
service line.

11. Deductible: If applicable, enter the reported deductible

amount.

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Apply Payment from Paper RA, cont.
12. Coinsurance: If applicable, enter the reported coinsurance
amount.

13. Copay: If applicable, enter the reported copay amount.

14. Status: If there is a remaining balance after the payment

amount is applied, click the drop-down arrow to select the
appropriate status update. Then, enter a reason code if
applicable.

15. Note: Enter any internal notes related to the payment amount
applied that will display when viewing transaction line details
on the corresponding Claim record.

16. Verify the posted transaction line(s) on the right side of the
window are correct.
Note: The transaction line(s) in bold are posted under the
Transactions section of the corresponding Claim record once
the payment is saved.
Tips for primary insurance payments:
• The sum of the Allowed, Contract Adj, and Secondary Adj
amounts should equal the charge amount.
• The sum of the Paid, Deductible, Coinsurance, and Copay
amounts should equal the Allowed amount.

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Apply Payment from Paper RA, cont.
17. To continue applying amounts of the payment, click Next Line if
the amount should be applied to the next service line listed, or
click to select the appropriate service line. Then, repeat steps 7-
17 as necessary.
• To return to the top options and add another encounter or
patient, click Add Encounter or Add Patient. Then, repeat
steps 3-17 as necessary.

18. When finished applying all payment amount(s) to the

corresponding service line(s), verify the Unapplied amount
displays $0.00 then click Save.
Note: Once saved, it is recommended to open the Payment
record and upload the paper RA under the Documents tab.
Refer to the Kareo account's agreement details and Pricing
Policy page for applicable document storage fees.
Tip: To view a report of how the payment was allocated,
open the Payment record, click Reports on the bottom of
the Edit Payment window and select Payments Application.

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Automatic Payment Posting
Kareo’s electronic remittance services include the delivery of electronic remittance advice (ERA) reports. All remittance reports are routed to
the practice(s) within your Kareo account and payments reported in an ERA can be automatically posted. The automatic posting supports
denials, reversals, underpayments, over-payments, and other complex electronic remittance scenarios. For more information about ERA
reports, review the Electronic Remittance Reports help article.

Post Electronic Remittance Advice (ERA) Payment

Follow the steps below to automatically post payments reported in an ERA.

1. Click Encounters > Clearinghouse Reports. The Find

Clearinghouse Report window opens.

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Post ERA Payment, cont.
2. Click the Electronic Remittance tab. The Electronic Remittance
reports list displays.

3. Double click the ERA report to open. The View Electronic

Remittance Advice window opens.
Note: It is recommended to address the ERA reports from
oldest to newest and confirm payment was received by check or
bank deposit prior to applying ERA payments.

4. Scroll down and review the ERA report information as

necessary.

5. Click Post Payment. The ERA payment amount(s) posts

automatically. Then, the General tab of the New Payment from
ERA window opens.
• If the ERA report included any payment amounts that could
not be posted automatically (e.g., payments for claims that
were not submitted through Kareo), the ERA Errors tab of
the New Payment from ERA window opens. Review the Post
Electronic Remittance Advice (ERA) Payment with ERA
Errors help article.

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Post ERA Payment, cont.
Verify New Payment from ERA Information
Once the ERA payment has automatically posted, it is important to
verify the information for accuracy prior to saving the payment.
When posting primary insurance payments, this also helps prevent
secondary electronic claim rejections for transferred balances.
Note: If the Unapplied Amount does not display $0.00 and there is
an ERA Errors tab, review the Post Electronic Remittance Advice
(ERA) Payment with ERA Errors help article.

1. Batch #: If applicable, enter a batch number for the payment.

Tip: Batch numbers are helpful for running reports when
there is a consistent naming convention such as the posting
date with the user's initials (e.g., MMDDYYYYAB). Then, when
running a report (e.g., Payments Detail), customize and filter by
that specific batch number.

2. Post Date: Auto-populates with the current date. If necessary,

enter a different posting date for the payment.

3. Type: Auto-populates with Insurance.

4. Insurance: Auto-populates with the payer in Kareo that could

be matched to the reported payer. If necessary, click Insurance
to search and select the appropriate payer.

5. Adjudication Date: Auto-populates with the reported

adjudication date.

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Post ERA Payment, cont.
6. Category: If the practice uses categories for certain payment
reports, click the drop-down arrow and select the appropriate
category. For more information about categories, review the
Categories help article.

7. Method: Auto-populates with Electronic Funds Transfer. If

necessary, click the drop-down arrow and select the
appropriate method.

8. Reference #: Auto-populates with the reported Check ID

number.

9. Amount: Auto-populates with the reported total actual payment

amount.

10. Notes: Auto-populates with the reported Notes/Title. If

applicable, enter any internal notes related to the payment.

(Continued next page…)

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Post ERA Payment, cont.
11. Select the Apply tab. Additional payment details display.

12. Click to select each patient, encounter, and/or service line to

review the auto-populated information.
Tip: The Next Line button can also be used to navigate to the
next service line.

13. Review the auto-populated Simple (EOB) payment information

and make any changes as necessary.
Note: It is especially important to ensure the amounts are
correct for balances transferred to secondary insurance policies
as this information is sent to payers that support secondary
electronic claim submission.

14. Verify the posted transaction line(s) on the right side of the
window is correct and make any changes as necessary.
Note: The transaction line(s) in bold are posted under the
Transactions section of the corresponding Claim record once
the payment is saved.

15. When finished, click Save. The payment is saved and the ERA
report is marked as reviewed.
Tip: To view a report of how the payment was allocated,
open the Payment record, click Reports on the bottom of
the Edit Payment window and select Payments Application.

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Additional Payment Posting Scenarios
This section of the guide covers additional common payment posting scenarios such as reversals, refunds, denials, and adjustments. For
more payment posting scenarios, browse the Post Payments help articles.

Payment Reversals
Some situations require a payment reversal (e.g., the insurance covers all or a portion of the patient’s copayment, the insurance overpaid or
paid in error). Once the applied payment amount is reversed, you can either refund the unapplied payment amount or apply it later to
another service line. For insurance overpayments, contact the insurance company directly for specific instructions.

Reverse Patient Payment

Follow the steps below to reverse a patient payment amount.

1. Click Encounters > Find Payments. The Find Payment window

opens.
Tip: For faster navigation, press F10 on your keyboard.

2. Find the payment then double click to open. The Edit Payment
window opens.
Tip: To return more accurate search results, select the All tab,
enter all or part of a keyword for the payment in the Look For
search bar, and click to clear "Show unapplied only" as
necessary. Then, click Find Now.

3. Select the Apply tab. The additional payment details display.

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Reverse Patient Payment, cont.
4. Click to select the service line with the applied payment amount
that requires the reversal.

5. Click More + in the lower right of the window. Additional

options display.
• If the service line was settled, click the drop-down arrow
and select Reopen. Then, click Post.

6. Click the drop-down arrow and select 1 - Payment. Once

selected, an additional field becomes available.

7. Enter the minus (-) sign and the payment amount that needs to
be reversed/unapplied (e.g., -12.34).

8. Click Post. The Payment transaction line for the reversal is

posted.

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Reverse Patient Payment, cont.
9. Verify the posted Payment transaction line reflects the correct
amount reversed.
• If the posted transaction line needs to be removed, right
click on the transaction line then select Remove.
• For additional actions (e.g., add note, settle service line),
click the drop-down arrow to select the appropriate option
and enter information as necessary. Then, click Post.
Note: It is recommended to add a note indicating the
reason for the payment reversal.

10. Verify the Unapplied amount reflects the correct total payment
amount reversed.

11. When finished, click Save.

The payment amount is now reversed and remains unapplied until

a refund is issued to the patient or the amount is applied to another
service line. For more information, review the Payment Refunds and
Apply Payment sections.

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Reverse Insurance Payment
Follow the steps below to locate and open the specific Payment record (related to the insurance payment that needs to be reversed) then
post the reversal of the payment amount(s).
Note: It is recommended to complete the Advanced Payment Posting training prior to posting insurance payment reversals. If you have
not completed this training and would like more information or have completed this training but need further assistance with posting an
insurance payment reversal, email your inquiry to [email protected].

1. Click Encounters > Track Claim Status. The Find Claim window
opens.
• If the Payment record details (e.g., payment ID, check
number, payer) are available, click Encounters > Find
Payments. Find the payment and double click to open it.
The Edit Payment window opens then proceed to step 4.

2. Find the claim with the applied payment amount that requires
the reversal and double click to open. The Edit Claim window
opens.

3. Under the Transactions section, double click the insurance

Payment transaction line to open. The Edit Payment window
opens.
Note: The insurance Payment transaction line description
includes the applied payment amount, Payment ID number, and
payer.

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Reverse Insurance Payment, cont.
4. Select the Apply tab. The additional payment details display.

5. Click to select the appropriate patient if necessary.

6. Click to select the appropriate encounter if necessary.

7. Click to select the service line with the applied payment amount
that requires the reversal.

8. Click More + in the lower right of the window. Additional

options display.
• If the service line was settled, click the drop-down
arrow and select Reopen. Then, click Post.

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Reverse Insurance Payment, cont.
9. Click the drop-down arrow and select 1 - Payment. Once
selected, an additional field becomes available.

10. Enter the minus (-) sign and the payment amount that needs to
be reversed/unapplied (e.g., -12.34).

11. Click Post. The Payment transaction line for the reversal is
posted.
• If the adjustment associated with the payment also needs to
be reversed, click the drop-down arrow and select 2 -
Adjustment. Additional fields become available. Click the
second drop-down arrow and select the adjustment code
previously used to post the adjustment. Then, enter
the minus (-) sign and the adjustment amount that needs to
be reversed (e.g., -12.34) in the field. When finished,
click Post. The Adjustment transaction line for the reversal is
posted. For more information about reversing adjustments,
review the Reverse Adjustment help article.

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Reverse Insurance Payment, cont.
12. Verify the posted transaction line(s) are correct.
• If a posted transaction line needs to be removed, right click
on the transaction line then select Remove.
• For additional actions (e.g., add note, settle service line,
transfer balance), click the drop-down arrow to select the
appropriate option and enter information as necessary.
Then, click Post.
Note: It is recommended to add a note indicating the
reason for the payment reversal.

13. Verify the Unapplied amount reflects the correct total payment
amount reversed.

14. When finished, click Save.

The payment amount is now reversed and remains unapplied until

a refund is issued to the insurance or the amount is applied to
another service line. Contact the insurance company directly for
specific instructions. Then, review the Payment Refunds and Apply
Payment sections as needed.

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Payment Refunds
You can create refund records for unapplied overpayment amounts that may have resulted from reversing insurance or patient payments.
For information on how to reverse payments, review the Payment Reversals section. Once refunds are created, they can be managed as
necessary to help accurately track statuses and payments associated with them. There are two workflows to create and post refund amounts
depending on how many payments, single or multiple, need to be added to the refund.

New Single Payment Refund

Follow the steps below to locate the payment and refund the unapplied overpayment amount for a single payment.

1. Click Encounters > Find Payments. The Find Payment window

opens.
Tip: For faster navigation, press F10 on your keyboard.

2. Find the payment then double click to open it. The Edit
Payment window opens.
Tip: To return more accurate search results, select
the All tab, enter all or part of a keyword for the payment in
the Look For search bar, and click to clear "Show unapplied
only" as needed. Then, click Find Now.

3. Click Refunds on the bottom of the window and select Refund

Unapplied Amount. The New Refund window opens.
Note: The payment is automatically added to the refund and
some information auto-populates from the payment. Edit the
information as necessary in the following steps.

(Continued next page…)

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New Single Payment Refund, cont.
4. Recipient Type: Auto-populates from the Payment record. If
necessary, click the drop-down arrow to select a different type
of recipient.

5. Refund Recipient: Auto-populates from the Payment record. If

necessary, depending on the Recipient Type,
click Patient or Insurance to search and select the refund
recipient, or enter the Other refund recipient.

6. Issue Date: Enter the date the refund is being issued.

7. Refund Method: Click the drop-down arrow to select how the

refund is being issued.

8. Memo: Enter any notes related to the refund.

9. Status: Click the drop-down arrow to select the status of the

refund, Draft or Issued.

10. Ref.#: Enter a tracking number for the refund (e.g., check,
confirmation, or authorization number).

11. Amount to Refund: Auto-populates with the total Unapplied

amount of the Payment record. If necessary, double click the
field under Amount to Refund column to enter a different
amount.

12. When finished, click Save.

© 2023 Kareo, Inc. The only complete technology platform for your independent practice | kareo.com 888.775.2736 | 32
New Multiple Payment Refund
Follow the steps below to create a new refund and post the refund amounts for multiple payments.

1. On the top menu bar, click Encounters > Find Refunds. The
Find Refund window opens.

2. To prevent duplication, verify the refund is not in the system.

Then, click New. The New Refund window opens.

3. Recipient Type: Defaults to Insurance. Click the drop-down

arrow to select Patient or Other.

4. Refund Recipient: Depending on the Recipient Type,

click Patient or Insurance to search and select the refund
recipient, or enter the Other refund recipient.

(Continued next page…)

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New Multiple Payment Refund, cont.
5. Issue Date: Defaults to the current date. Enter the date the
refund is being issued.

6. Refund Method: Click the drop-down arrow to select how the

refund is being issued.

7. Memo: Enter any notes related to the refund.

8. Status: Click the drop-down arrow to select the status of the

refund, Draft or Issued.

9. Ref.#: Enter a tracking number for the refund (e.g., check,

confirmation, or authorization number).

10. Click Add. The Select Payment window opens. Search for and
double click to select the payment to add to the refund. Repeat
this step as necessary.
• If a payment was added in error, click to select it. Then,
click Delete and the payment is removed from the refund.

11. Amount to Refund: Once all payments are added, double click
the field under the Amount to Refund column and enter the
refund amount for each payment listed.

12. When finished, click Save.

© 2023 Kareo, Inc. The only complete technology platform for your independent practice | kareo.com 888.775.2736 | 34
Insurance Denials
When you receive paper denials from payers, you can manually post the denials to more effectively track and report claim denials. Tracking
claim denials help determine internal patterns and trends, as well as those with specific payers, to quickly identify and remediate the
common issues causing the denials. For information on how to find and view a denied claim, review the Find and View Denied Claim section of
the Post and View Denied Claims help article.

Manually Post Claim Denial

1. Create a new insurance payment and enter the information as
necessary under the General tab with the following. For more
details, review the Enter Payment from Insurance section.
• Method: Click the drop-down arrow and select 1 - Check as
the method since this is a zero dollar amount payment.
• Amount: Leave as $0.00.

2. When finished, click Apply Now. The Apply tab opens.

(Continued next page…)

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Manually Post Claim Denial, cont.
3. Add Encounter: Selected by default. To add service lines by
patient, click the drop-down arrow and select Add Patient.
Note: When an encounter is added, all service lines
associated with the encounter are listed. When a patient is
added, all open service lines associated with the patient are
listed.

4. Enter the encounter ID or patient’s name. Then, press Enter on

the keyboard. The service lines are listed.
Note: The encounter ID may be indicated as the Patient
Account Number or Claim Reference ID on the payer report as
follows Encounter ID + Z + Kareo ID (e.g., 176Z15050).
Tip: Enter the encounter ID + Z (e.g., 176Z) to quickly add the
appropriate record and avoid having to search and select it.
• If the Select Encounter or Find Patient window opens, search
and select the appropriate record.

5. Show Only: Defaults to Selected. If necessary, click the drop-

down arrow to select to list All, Open, Settled, or Negative
Balances service lines.

6. Click to select the patient, encounter, and/or service line for the
denial.

7. Under the Simple (EOB) tab, leave all amount fields as $0.00 and
ensure the Status is set to Default.

(Continued next page…)

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Manually Post Claim Denial, cont.
8. Select the Advanced (ERA) tab. The Advanced (ERA) information
displays.

9. Click More +. Additional options display.

10. Click the drop-down arrow and select Reason. Once selected,
additional fields become available.

11. Enter the denied amount.

12. Click the drop-down arrow and select the reported denial
reason code.

13. Click the drop-down arrow and select the reported claim
adjustment group code.

14. Click Post. The Reason for the denial is added. This will display
when viewing the Denial transaction line information on the
corresponding Claim record.

(Continued next page…)

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Manually Post Claim Denial, cont.
15. To continue, click Next Line if the denial applies to the next
service line listed, or click to select the appropriate service line.
Then, repeat steps 7-15 as necessary.
• To return to the top options and add another encounter or
patient, click Add Encounter or Add Patient. Then, repeat
steps 4-15 as necessary.

16. When finished with the denial, click Save. If a confirmation pop-
up appears, click Yes to post the payment with a $0.00 amount.

© 2023 Kareo, Inc. The only complete technology platform for your independent practice | kareo.com 888.775.2736 | 38
Adjustments
You can easily adjust a balance that no longer needs to be billed and collected by the practice (e.g., small balance). There are two common
workflows:
• Post an adjustment related to a specific Payment record and use that payment's posting date.
• Post the adjustment on the Claim record to use the current posting date, and if applicable, relate the adjustment to a specific
Payment record.

Post Adjustment on Payment Record

Follow the steps below to locate and open the specific Payment record related to the adjustment then post the adjustment amount(s).

1. Click Encounters > Track Claim Status. The Find Claim window
opens.
• If the Payment record details (e.g., payment ID, check
number, payer) are available, click Encounters > Find
Payments. Find the payment and double click to open it.
The Edit Payment window opens then proceed to step 3.

2. Under the Transactions section, double click the Payment

transaction line for the Payment record the adjustment is
related to. The Edit Payment window opens.
Note: The Payment transaction line description includes
the applied payment amount, Payment ID number, and the
source (e.g., patient, insurance).

(Continued next page…)

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Post Adjustment on Payment Record, cont.
3. Select the Apply tab. The additional payment details display.

4. Click to select the patient, encounter, and/or service line with

the balance that needs to be adjusted.

5. Click More + in the lower right of the window. Additional

options display.

6. Click the drop-down arrow and select 2 - Adjustment. Once

selected, additional fields become available.

7. Click the drop-down arrow and select the appropriate

adjustment code.

8. Enter the amount that needs to be adjusted.

9. Click Post. The Adjustment transaction line is posted.

• If the adjustment creates a zero balance, click the drop-
down arrow and select Settle to settle the claim. Then,
click Post. The Settled transaction line is posted.

10. Click Save.

© 2023 Kareo, Inc. The only complete technology platform for your independent practice | kareo.com 888.775.2736 | 40
Post Adjustment on Claim Record
Follow the steps below to post the adjustment on the Claim record to use the current posting date, and if applicable, relate the adjustment to
a specific Payment record.

1. Click Encounters > Track Claim Status. The Find Claim window
opens.

2. Find the claim with the balance that needs to be adjusted then
double click to open it. The Edit Claim window opens.

3. Click Action and select Adjustment from the menu. Additional

options display.

(Continued next page…)

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Post Adjustment on Claim Record, cont.
4. Type: Defaults to 2 - Adjustment.

5. Posting Date: Defaults to the current date. If necessary, enter a

different posting date.

6. Adjustment: Enter the amount that needs to be adjusted.

7. Adjustment Code: Click the drop-down arrow and select the

appropriate adjustment code.

8. Reason Code: Click the drop-down arrow and select the

appropriate reason code for the balance.

(Continued next page…)

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Post Adjustment on Claim Record, cont.
9. Change Status: Click the drop-down arrow and select the
appropriate status update.
• If there's a balance after the adjustment, select to Bill
patient or Bill payer.
• If the adjustment creates a zero balance, select Settle to
settle the claim.
• To keep the current status after the adjustment, select
None.

10. Related Payment: If applicable, click Related Payment to

search and select a Payment record the adjustment is related
to.

11. Note: Enter any internal notes related to the adjustment that
will display when viewing transaction line details on the Claim
record.

12. Verify the information entered is correct. Then, click Apply. The
Adjustment transaction line is posted and automatically saved.
If the option to change the status was selected, an additional
transaction line is posted.

© 2023 Kareo, Inc. The only complete technology platform for your independent practice | kareo.com 888.775.2736 | 43
Learn More
Help Center
Explore helpme.kareo.com to view additional help resources, monthly product release notes, help articles, guides, training videos, support
contact information and more.

Kareo University
Log into app.kareo.com to access Kareo University and register for live trainings, view pre-designed courses and eLearnings. Review the
Kareo University help article for more details.

Guides
Review the Billing section of the User Guides page for additional resources to help set up your billing company for success.

© 2023 Kareo, Inc. The only complete technology platform for your independent practice | kareo.com 888.775.2736 | 44
Kareo is the leading cloud-based complete medical technology platform purpose-built to meet the unique needs of
independent practices in more than 45 specialties.

Today Kareo helps over 75,000 providers in all 50 states run more efficient and profitable practices, while delivering
outstanding patient care. The Kareo technology platform is the first to help independent practices find more
patients, manage their care with a fully certified and easy-to-use EHR, and get paid quickly all in one complete and
integrated package.

Kareo has received extensive industry recognition, including the Deloitte Technology Fast 500, Inc. 5000, and Black
Book’s #1 Integrated EHR, Practice Management and Medical Billing vendor, as well as ranking at the top of the
Leader Quadrant in the FrontRunners Software Analysis of EHR. Kareo’s growth further demonstrates the expansion
and vitality of the independent practice market in the U.S. With offices across the country, Kareo’s mission is to help
independent practices succeed in an ever-changing healthcare market. More information can be found
at www.kareo.com or by calling 888-775-2736.

© 2023 Kareo, Inc.