Wiki Payer Payment's over the Allowable Amount

[nilsafer]

Hello! I have an EOB from Carelon (they handle Humana Medicaid for Mental Health); in which they paid about $30 over what we have as the allowable amount in our PM (AdvancedMD).

This is the first I have bumped into this, so my question is - what is the best procedure for this?
i.e. Will it be ok to adjust it in our PM without running any risks if we are audited?

I assume since it since we manually entered the allowable amounts manually into our PM, that it can be updated / corrected, is it safe to assume that?

 

[csperoni]

My bet is the allowable amount you have loaded into your system is simply incorrect or outdated. It would be best if you did correct it.
FYI - don't forget even the same payor may have different allowable amounts for different types of plans. For example, Oxford Medicare, Oxford Metro and Oxford Freedom could all have different fee schedules for the same CPT.

 

[nilsafer]

That's what I imagined, to adjust the systembut did not want to make a mistake in case of an audit.

Correct, they are all different - each fee schedule we have is different especially Medicaid!

Thank you!!!