Author Topic: How to post a payment when the claim was processed to the member  (Read 137 times)

romyamilca

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We are an out of network provider and some of our claims at Beacon and FL Blue are paid to the member. when the member sends us the check they received from their insurance do I post that as a patient payment or an insurance payment. Should I be using the Member EOB?

Michele

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Re: How to post a payment when the claim was processed to the member
« Reply #1 on: October 11, 2017, 07:36:52 AM »
It is up to you and how your system is set up as to how you enter the payment.  Personally if the patient signs the check over to the dr then we post it as an insurance payment.  If the provider is OON then it is ok to use the Member EOB.
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PMRNC

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Re: How to post a payment when the claim was processed to the member
« Reply #2 on: October 11, 2017, 11:37:28 AM »
Technically and for audit purposes,  if the patient signs the check over to you it's a patient payment. It would be no different than if the patient put the check into their acct and then wrote you a check. Also, IF this is a group health plan goverened under ERISA, the claim was the patient's and the reimbursement was the patient's making the payment to you from them in any form a patient payment.

Many BCBS plan's don't have to honor assignment of benefits so we always collect at the time of service for my clients that don't par with BCBS to avoid that. 
Linda Walker
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Michele

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Re: How to post a payment when the claim was processed to the member
« Reply #3 on: October 11, 2017, 11:52:33 AM »
Technically and for audit purposes,  if the patient signs the check over to you it's a patient payment. It would be no different than if the patient put the check into their acct and then wrote you a check. Also, IF this is a group health plan goverened under ERISA, the claim was the patient's and the reimbursement was the patient's making the payment to you from them in any form a patient payment.

Many BCBS plan's don't have to honor assignment of benefits so we always collect at the time of service for my clients that don't par with BCBS to avoid that. 

Thanks for clearing that up.  We don't run across that hardly ever personally.  As I typed out the response I was thinking "I wonder how Linda would answer this."  :)
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PMRNC

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Re: How to post a payment when the claim was processed to the member
« Reply #4 on: October 11, 2017, 12:45:59 PM »
Most of the time patient's just keep those checks and it's a PIA to collect! It's actually pretty rare a patient brings in the insurance check <g>

I don't understand how general practices and surgeon's handle this without participating with those BCBS plans.
Linda Walker
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