Medical Billing Forum
Payments => Insurance Payments => : Gayle33 June 16, 2015, 01:56:51 PM
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If the primary insurance did not make a payment because it applied to patients deductible and the secondary paid according to their fee schedule, which write off/adjustment do I use, the primary's or secondary's?
Example: Total charges is $395. Primary allowable $225.13 went to pt's deductible with a write off of $169.87
Secondary paid as primary since primary did not pay. they paid $219.58 with a write off of $119.40, stating patient bal. is $56.02.
Do we use the primary's write off/adjustment or the secondary's?
Thank you
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Secondary paid as primary since primary did not pay. they paid $219.58 with a write off of $119.40, stating patient bal. is $56.02.
Do we use the primary's write off/adjustment or the secondary's?
The higher allowable in your example is what will determine the adjustment.
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Thank you!!
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Just curious, what is the reason the higher allowable is allowed, because it's the secondary? How come if the secondary has a lower allowable, you have to write off that difference, and not collect the full allowable of the primary?
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the higher allowable determines the participating adjustment with one or both plans (participating). Even if it was the primary allowable that had the higher allowable that still determines the par adjustment.
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Our members only area has a great downloadable COB guide that not only shows billers how to determine primary carrier, but how to calculate benefits using the three most common methods of COB which is determined by verifying benefits with the secondary. If you are a PMRNC member you can find this guide by visiting the Learning center and clicking on Coordination of Benefits. If you are not a member, I encourage you to join. www.billerswebsite.com