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Insurer Underpayment (adjusting amount paid by insurer)

Sometimes you bill one amount to the insurer, but the amount they paid is less than what you billed.

This might be because the client’s coverage changed, or they maxed out their plan, or there was a clerical error, or one of the many, many, other reasons that insurance billing can be a bit complicated!

When you are underpaid there are two scenarios - the first is that you want to bill the amount that was not paid by the insurance company to the patient, the second is you want to write off the unpaid amount and not collect at all.

Unpaid Amount Billed Back to Patient

There are a few steps to changing this under payment, so I’ll go through them here one at a time.

  1. Unapply the Insurer Payment (if it’s been applied).
  2. Edit the max amount on the Insurance Claim for that visit
  3. a. If the claim is set to patient pays remainder the difference will automatically be billed to the patient
  4. b. If the claim has a set user fee you will need to increase the user fee manually to account for the difference.
  5. Re-apply the insurer payment to the now corrected invoiced amount.

Let’s break those down in more detail.

Unapply the Insurer Payment

View the Insurer Payment by Clicking on the Insurer Invoice in question from the Patient’s Billing Tab.

Scroll Down and you will see the Insurer Payment listed on the invoice.

Click on the Blue Payment number:

Find the under payment that was recorded on the invoice.

Once unlinked you can then save that payment and return to the patient’s Billing Profile.

Edit the Max Amount

View the Purchase using the View button at the end of the line, and then update the Max Amount to the amount actually paid by the insurance company.

User Fee/Gap Payment

If the claim is set to patient pays remaining, then the difference will automatically be assigned to the patient. Otherwise, add it in the user fee field.

Re-apply the insurer payment

From the drop down beside the “view” button, choose to receive the insurer payment.

Use the credit to repay the now correctly displaying invoice.

This is quite a detailed look at the steps needed, but really it’s much simpler as long as the underpayment is NOT RECEIVED IN JANE until after the invoice max amount is updated. That really reduces the steps needed to make the change.

Unpaid Amount to be Written Off (not collected).

  1. Apply the Insurer Payment
  2. View the Insurer invoice and use the drop down to Write Off the remaineder

Write Off Remainder

View the Insurer Invoice from the Patient’s Billing Tab as shown above. Click on the blue words that say “Insurer Invoice” to open up the invoice.

Use the drop down beside the Cancel button and then choose the “Write Off” option.

This was quite a detailed look and if you still have questions let us know and we’d be happy to walk through the different steps together with you on the phone.