Feature Suggestion – Visit-Level Payment Posting, Denial Tracking & A/R Management

Hello CareSmartz360 Team,

I would like to suggest an enhancement to the current Accounts Receivable and payment posting functionality within CareSmartz360, specifically regarding how payments, deductions, denials, and appeals are managed.

Currently, the system primarily allows payments to be received and applied at the invoice level. However, for agencies working with Medicaid and LTC insurance providers, payments and adjustments are often processed at the individual visit level rather than the entire invoice.

This creates challenges when reconciling insurance payments, particularly when certain visits are paid in full, partially paid, denied, or adjusted.

1. Visit-Level Payment Posting

I would like to suggest adding an option under either the View Finalized Invoices or View Claims screen that allows agencies to receive and apply payments directly to individual visits.

Ideally, this feature would allow us to:

• Select multiple visits and apply the full billed amount as payment to each selected visit simultaneously.
• Select an individual visit and apply a partial payment when the insurance pays less than the billed amount.
• Add a note, deduction reason, or payment memo to a specific visit explaining why the payment was reduced.
• Automatically calculate and display the remaining outstanding balance for each visit.
• Apply payments to multiple visits from the same insurance remittance without having to process each one separately.

For example, if an invoice contains 50 visits and the insurance pays 45 in full, partially pays 3, and denies 2, we should be able to reconcile all 50 visits individually without having to manually adjust the entire invoice.

2. Denial and Appeal Tracking

Another extremely valuable feature would be the ability to track denied and appealed visits directly within the View Claims screen.

For example, agencies could select one or multiple visits and update their payment/claim status to:

• Paid
• Partially Paid
• Unpaid/Pending
• Denied
• Appealed
• Resubmitted
• Adjusted/Written Off

It would also be helpful to have the ability to add notes to each visit, such as the denial reason, appeal submission date, insurance reference number, or any follow-up actions taken.

This would allow agencies to monitor outstanding A/R much more effectively, quickly identify denied or underpaid visits, and keep track of which claims require follow-up.

Ideally, these statuses could also be filtered so we could easily generate a list of all denied visits, pending appeals, partially paid visits, or outstanding balances.

3. Simplifying the Current Accounts Receivable Workflow

I also wanted to mention that the current Accounts Receivable and payment posting functionality feels unnecessarily complicated. There are several different screens and options involved in managing invoices, claims, payments, and receivables, which makes the overall process confusing and less efficient than it could be.

I believe much of this functionality could be consolidated and organized within the existing View Claims screen, creating a more centralized workflow.

For example, from one screen, agencies could:

• View submitted claims and their associated visits.
• Post full or partial payments at the visit level.
• Record deductions, adjustments, and payment memos.
• Update denial and appeal statuses.
• Review outstanding balances and payment history.
• Filter claims by insurance provider, payment status, denial status, and date range.

This would eliminate the need to navigate between multiple screens to complete what is essentially one A/R reconciliation process.

4. Overall Goal

The main objective is to make CareSmartz360's Accounts Receivable functionality more practical and efficient for agencies managing a high volume of insurance claims.

Having the ability to reconcile payments at the visit level, track denials and appeals, and manage outstanding balances from one centralized screen would significantly improve accuracy, reduce manual administrative work, and provide much better visibility into the agency's actual A/R.

I believe these enhancements would make CareSmartz360 a much more comprehensive solution for agencies that rely heavily on Medicaid and managed long-term care insurance reimbursements.

Thank you for taking the time to consider these suggestions. I would appreciate hearing whether any similar functionality is currently available or being considered for future development.