Wiki Secondary has higher allowable than Primary

[Cher91600]

I tried in the reimbursement thread, but haven't had much luck, I'm hoping a broader audience may help.

Here is my issue:

UHC is the primary on this claim, with BC/BS as secondary. UHC's allowable amount is lower than BC/BS. So here is the breakdown

UHC Allowed Paid BCBS Allowed Paid
Code 1: $ 70.57 $55.54 Code 1: $ 88.49 $ 0
Code 2: $ 9.89 $ 9.89 Code 2: $ 13.59 $ 3.70
Pt. Resp: $ 15.00 Pt. Resp: $ 21.62

Do we accept the Primary Insurance Adjustment & apply the $3.70 towards the initial patient balance of $15 or do we shift the allowable amount to the secondary for the Code 2 payment, but leave the balance due at $15 for the copay on code 1?

Thank you for any guidance that may be offered.

 

[mrsjehu]

I would shift the adjustment. I would just definately be sure that the secondary is using their allowable and not the primary's. If that is they way they process the claims that is fine. You just don't want an overpayment that they will later want back

 

[shenell333@yahoo.com]

Hi

Code 1 if primary allowed $70.57 and paid $55.54 Pt responsibility is 15.03. If secondary paid nothing then pt balance will still be $15.03

Code 2 if primary allowed and paid 9.89 why did it go to secondary?

You can't use credits that is paid for one code to put towards a patient balance on another code. I would make sure secondary process the claim as secondary and not primary.