What a Failed payment means
The payment has come into the system (electronically through ERA), but it was unable to connect to a specific Invoice/Claim and therefore did not auto-apply the payment.
The payment was deleted from an Invoice/Claim. In this case, it would need to be re-applied/applied to the correct Invoice/Claim.
Note: If you do not have an invoice to connect to the failed payment, it is because the claim was not billed through Niko Health and is considered a legacy payment.
Failed payments should be worked daily to make sure money is being applied to the correct Invoice/Claim. For helpful tips on Payments, visit our Payment Posting Checklist.
How ERA payments get into NikoHealth
Electronic payments come in two stages. A failure can happen at either one.
Stage | Where | What the system matches on |
1. Match the remit to a payer | EOB/ERAs | The remittance payer ID on the remit must match the payer ID on the payer in NikoHealth |
2. Match the payment to invoices | Payments queue | The claim control number sent with the claim |
Step 1: Fix remits that don't match a payer
A remit matches a payer when the remittance payer ID on the remit equals the Remittance ID on the payer in NikoHealth. If they don't match, every remit from that payer fails.
In EOB/ERAs, find the Remittance Payer ID column on the remit. Note the ID.
Go to Management › Billing Setup › Payers. Find the payer and click Edit. On the Details tab, go to Claim Options and find the Electronic Claims box.
Check the Remittance ID field. Don't change the Payer ID field. The Payer ID is used to submit claims. Remits are matched on the Remittance ID field only.
If the Remittance ID is blank or wrong (for example, set to "test"), enter the remittance payer ID from the remit. This stops future remits from that payer from failing.
Click Save.
Step 2: Connect a failed payment to the invoice
Go to Billing › Payments and filter by status Failed.
Open the payment. It shows all the information from the remit. Click Edit.
Click Connect at the invoice (top) level first. You can't connect service lines until the invoice is connected.
Search for the patient or invoice and select the correct invoice.
Connect each service line.
Click Save.
Tip: The account number on the remit is often the claim control number. You can search invoices by Claim Control #. Payers sometimes add extra digits to the front, so try again without them if you get no match.
Step 3: If there is no invoice, mark the payment as legacy
If you search and the patient or invoice isn't in NikoHealth, the claim was billed outside NikoHealth (for example, from your previous system during go-live). This is a legacy payment.
On the payment, click the blue + and select Edit Payment Details. Check Completed and Legacy.
Click Save.
What this does:
The status changes from Failed to Completed.
The payment is flagged as Legacy, so you can separate it from NikoHealth revenue in reporting.
During go-live: Expect a mix of legacy and NikoHealth payments while you finish billing out of your old system. Work them one at a time so every payment is reconciled.
Reporting legacy payments
Run the Payment Detail report. Use the Legacy column to find payments marked Yes, and subtract them from your NikoHealth totals.
Troubleshooting
Problem | What to check |
The same payer keeps failing | The payer ID in NikoHealth doesn't match the remittance payer ID. See Step 1. |
I can't click Connect on a service line | Connect the invoice (top level) first. |
The invoice doesn't come up in search | Search by claim control number. Check whether the invoice is billed to the patient or another payer. If it isn't in NikoHealth at all, it's a legacy payment (Step 3). |
The payment was deleted from an invoice | Connect it again to the correct invoice (Step 2). |
The payment has a take-back or PLB | See [Posting Payer Recoupments and Payment Reversals] or [Posting Offsets, Forwarding Balances, and Other PLB Adjustments |