Author Topic: secondary Ins.  (Read 4440 times)

Michele

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Re: secondary Ins.
« Reply #15 on: February 05, 2009, 12:31:48 PM »
I do post the adjustments on my system, but my claim prints out with the original charges and I don't mess with the paid and amount due collumns.  I actually had many provider reps tell me leave them alone, they will take the info from the eob.  They prefer it that way.

Michele
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Pay_My_Claims

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Re: secondary Ins.
« Reply #16 on: February 05, 2009, 01:05:10 PM »
Oh, I don't adjust the amounts. I just don't do the primary adjustments. I drop the entire balance from the primary to the secondary.

EX: We bill BCBS 300, they allow 200, and pay 80% ucr.  The balance would be 40.00 since they will pay 160 of the claim. I don't adjust 100, then post 160 and leave the 40. I post 160 off the 300 and drop 140 to Cigna. The amount billed with always be the same, the amount paid will be the same, the amount owed on our HCFA will be different. You will only be billing cigna for 40 while I bill them 140.
Cigna looks at the claim, looks at the code, see what their allowables are and pays according. If BCBS paid more than what cigna allowed, they will pay nothing, and the client can't be billed according to your contract. Even if you only drop the 40, you will recieve the same denial code (exceeds our allowable, PR is 0). So why do the adjustment???

I am still researching to see if any laws on billing are against this. I have recovered more for my providers doing it this way. Why would an insurance company tell you to keep the adjustments on???
Also, I only bill like this with commercial insurance. Medicaid has a different guideline and i totally follow that.

Pay_My_Claims

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Re: secondary Ins.
« Reply #17 on: February 05, 2009, 01:52:38 PM »
Here is an article that I read on posting secondary insurance. It does describe what is most common (adjust the non allowed)

http://www.chiroweb.com/mpacms/dc/article.php?id=52286


Michele

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Re: secondary Ins.
« Reply #18 on: February 05, 2009, 05:31:20 PM »
When I'm posting the primary payment, I put in a contractual adjustment for the amount over their allowance.  But that is just in my system.  When I send it out I send out the original amount billed along with the eob and let the secondary pay what they will.  I find that they do pay more than the primary allows in many cases.  I'm not aware of any law against this since I'm charging the same amount to both insurance carriers, and I'm not billing the patient any more than the insurance carrier tells me I can.  If I don't record the adjustment from the primary, when the secondary payment comes in I would have to look up the primary if I needed it.  This way it's already there.  If they pay more, then I just make that adjustment as well.

I guess it's all what works best for you!  :) A million ways to get the same outcome.

Michele
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Pay_My_Claims

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Re: secondary Ins.
« Reply #19 on: February 05, 2009, 05:33:42 PM »
So so true. Neither of us is billing the client for more than the contracted rate.....
Its still good to know how to fish another way *smile*