Author Topic: Coordination of Benefits adjustments  (Read 1824 times)

Gayle33

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Coordination of Benefits adjustments
« on: June 16, 2015, 10:56:51 AM »
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 

PMRNC

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Re: Coordination of Benefits adjustments
« Reply #1 on: June 17, 2015, 05:58:48 PM »
Quote
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.

Quote
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.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Gayle33

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Re: Coordination of Benefits adjustments
« Reply #2 on: June 18, 2015, 08:20:52 AM »
Thank you!!

dekenn

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Re: Coordination of Benefits adjustments
« Reply #3 on: June 18, 2015, 09:22:47 AM »
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?

PMRNC

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Re: Coordination of Benefits adjustments
« Reply #4 on: June 18, 2015, 09:39:52 AM »
 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.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

PMRNC

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Re: Coordination of Benefits adjustments
« Reply #5 on: June 18, 2015, 09:41:37 AM »
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
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com