Author Topic: Overpayment scenario  (Read 23 times)


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Overpayment scenario
« on: August 15, 2018, 10:07:56 AM »
I am very new to this position and am learning as I go. Not sure how to proceed here - a personal injury patient's auto insurance covered 80% of our claim. I submitted to BCBS for secondary, they covered 100% of the allowable amount resulting in a total payment of $256.26 on a $210 claim.

Here is a detailed breakdown of remits:
Charge $210
Auto paid $168
Patient CoPay due $42
Submitted to secondary
BCBS paid $88.26
Contractual Adjustment of $121.74

I think BCBS didn't take the prior payment information into consideration? Any direction is greatly appreciated :)


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Re: Overpayment scenario
« Reply #1 on: August 15, 2018, 08:39:29 PM »
I don't deal with auto accident claims, so my knowledge is limited, but I would think that they would be the only insurance you could bill in this scenario, and it shouldn't have gone to BCBS at all. Someone will correct me if I am wrong.

That said, when you submitted claim to BCBS, did you include EOB from auto insurance payment? If not, that could be part of the issue.