Question
QUESTION: My appologies in advance, this is a tad long. When a pt has dual coverage, upon receipt of the primary eob showing payment, contractuals etc., and have recorded these amounts in the patient account, I then submit to the secondary for payment consideration. When the secondary allowed more than the primary and pays a few dollars for this reason, recording the secondary payment and contractual information in the patient account as shown on the EOB can result in a credit due to the contractuals shown on the eobs. Which contractual do you adjust in order to not have this 'false credit'? (we use different codes per insurance company, such as a 1 series is a payment from Commercial insurance and a 7 series may be the payment from a Medicaid) Thank you so much for your time, Dee
ANSWER: Hi Dee Dee!
I am not to clear on what you mean about a false credit......however I will try to explain what I think you want to know.
When a patient has both a primary and secondary carrier, you must bill the primary first. Once they pay you credit the invoice with payment and with any contractual adjustment. Then send the balance to the secondary after all the credits including adjustments.
Once secondary pays, they will usually show you on the EOB what patient owes. With two insurances usually the patient will owe very little. Sometimes the secondary may have an adjustment also that you may have to consider before billing the patient but this is rare.
Hope this answers your question.
Tricia
---------- FOLLOW-UP ----------
QUESTION: My prior question was confusing. Maybe this will show what I was trying to ask..Example would be such as this:
Ofc visit: $126 with a $15 lab, $20 lab and $10 lab. Primary payment and contractual on EOB leave a zero balance for each line except the $15 applied to copay. This $15 is now submitted to secondary. The secondary sends a check for $22.21. The secondary has allowed more for the labs than the primary had allowed, so now I have a payment for the $15 copay, and $2.12 for the $15 lab, $3.77 for the $20 lab and $1.32 for the $10 lab. At this point I now have $7.21 credit, due to I started with zero balances on all lines except the line that had the $15 copay remaining.
Answer
Hi!
I would consider the secondary payment as an overpayment since they are only responsible to pay the balance that the primary did not pay. Even if the secondary allows more they are not suppose to pay the higher amount.
We have had that happened where I work a few times and usually the secondary comes back and asks for a refund. So we apply overpayments to a credit account leaving them hang for now. Does not affect the patients copay amount.
Hope this helps!
Tricia
