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You can use the FIFO or First In, First Out spread, to apply the payments starting with the oldest line items by the create date until the payment is distributed.
You can use the FIFO - Patient Responsibility Date spread to apply payments to the oldest line items determined by the patient responsibility date, until the payment is distributed. Whenever a transaction is entered for a non-third party payment, for example a patient payment, the application applies the payment FIFO to the patient responsibility.
NextGen Healthcare recommends FIFO-patient responsibility for patient transactions.