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Differences Between the Aging Report and the Insurance Claim Aging Report

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Why doesn't the Aging Report's 'Ins Est' match any number on the Insurance Claim Aging Report?

The table below shows the differences between these the way these two reports calculate the insurance estimate. As you see, with the numerous differences, it is very rare to see these two reports agree. These numbers may not match for several reasons.

Aging ReportSummaryInsurance Claim Aging Report
Follows totals numbers as summarized and displayed in the Ledger.Calculated in realtime from the insurance claims themselves.
Aging ReportReport OptionsInsurance Claim Aging Report
Select Guarantor< Matches >Select Patient
Select Primary Provider< Matches >Select Primary Provider
Select Billing Type must select From All To All< 'ALL'No option, All Billing Types assumed
Min Balance to Print must select All< 'ALL'No option, All Balances assumed
Last Pmt Before must select < 'CURRENT'No option, assumed
Minimum Days Past Due< Matches >Minimum Days Past Due
No option, Dental Assumed'Dental' >Select Report Type must select Dental
Calculate Aged Balance as of is not selected.
If this is selected, the INSR EST column is removed.
This report includes insurance claims created today.		< Not SelectedNo option, report assumes yesterday's date.
This report does not include claims created today.

Aging ReportCalculation DifferencesInsurance Claim Aging Report
'Ins Est' on the Aging Report is the total of the 'Expected From Insurance' on Ledger of all people with outstanding claims regardless of the aging of the account or the age of the insurance claim.Aging reports insurance estimates calculated real-time based on current insurance coverage.
'Estimate' on the Insurance Aging Report is the total of all of the 'Est Ins Portion' on ALL OUTSTANDING CLAIMS, not just the current month.The Insurance Claim Aging reports insurance estimates stored in the claim at the time the claim is created.  This is static unless claim is deleted and recreated.
'Current' is the total of all of the 'Total Billed' on the claims in the current month. This is generally the same as the Ledger's 'Outstanding Billed to Insurance'
On the Aging Report:  '31-60,' '61-90,' 'Over 90,' and 'Balance' are equal to the total balances for all patients within that time frame.On the Insurance Claim Aging Report: '31-60,' '61-90,' 'Over 90,' and 'Total' all are calculated by adding the 'Total Billed' on the insurance claims for that time period.
Aging ReportIncluded / Excluded ClaimsInsurance Claim Aging Report
Takes into account plan maximums.Does not take into account plan maximums.
Includes secondary insurance even if the claim is not created.Only claims created and sent (printed, batched, or eSent) are included.
Claims created today (aged 0 days) are included.Claims created today are not included (claims must be 1 day or older).
Claims created, but not sent (printed, batched, or eSent) are included.Claims created, but not sent (printed, batched, or eSent) are excluded.
Claims created for a patient who no longer has that carrier in Family File are excluded.Claims created for a patient who no longer has that carrier in Family File are included.
Claims with a future date are includedClaims with a future date are excluded.

ADDITIONAL INFORMATION:

Other possible reasons these reports estimate are / can be / will be different:

  1. Insurance company coverage table has changed since claim was created.
  2. Insurance company payment table has changed since claim was created.
  3. Insurance company for patient has changed since claim was created.  Claim has static estimate from old insurance coverage, aging calculates with current coverage

When looking at the Balances on the reports keep this in mind:

  1. Insurance Claim Aging reports the total outstanding from insurance.
  2. Aging reports the total balance still owed on a patient's account.
    Example:  If you have a claim for $500 and the insurance has not paid but the patient paid their part of it ($200,) the Insurance Claim Aging will add the full $500 to the total balance, while the Aging report will only add $300 to the total balance.  This will leave a difference of $200 in the balance between the two reports.

Keywords: compare vs versus estimating ins balance wrong difference different, Solution #: 1-J6-693
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Differences Between the Aging Report and the Insurance Claim Aging Report
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