Forum - Questions & Answers

Dec 3rd, 2015 - bspainhour 1 

Claim adjustments

Can someone help me understand how one claim can be credited with an adjustment twice. The claim was for 120.00. The first payer adjusted 3.37 and put 116.63 toward the patient's deductible. The HSA payer adjusted the claim again for 3.37, paid a portion of the balance (78.80), leaving the balance to be paid by the patient (non-covered charges). Thus the amount is credited with two adjustments. Can I recover the second one from the patient?? It doesn't seem fair that there be two adjustments for one claim. What am I missing??

Thanks. (I know this is not code related).

Dec 3rd, 2015 - afgbilling 59 

re: Claim adjustments

You do not do the adjustment from the secondary payer, but according to my calculations I came up with the patient owing $34.46, not a credit. By not doing the second adj of $3.37, the patient would owe $37.83. This is how I understood your question, unless I missed something.

Dec 4th, 2015 - LBAROGIANIS 250 

re: Claim adjustments

The first insurance stated that 116.63 is allowed and applied to deductible. You are say that the second insurance allowed 113.26 and paid 78.80, leaving the balance to the patient which would be $34.46. Make sure that the second allowable is correct.

Dec 4th, 2015 - Ashfaq756 1 

re: Claim adjustments

Do not adjust the balance while posting HSA payment, just post the payment and non covered amount need to bill to patient. HSA is part of primary insurance it's not a secondary insurance.

Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association