General Category > General Questions

Timely Filing Denial and patient copay

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shannon29073:
When the claim denies for timely filing and it is the providers fault- Do you have to refund the patient's copay?

Since the provider didn't follow the guidelines set forth in their contract- Is the patient still responsible for the copay?

Thanks!

Pay_My_Claims:
We wouldn't "refund" we would just credit the account. I had a couple of those when I started at a new practice, and I had to review the current AR. Most providers don't like to refund, but thats a totally different post. Now, I can tell you if you are non-par, they will deny with patient responsible, but it doesn't mean you will get paid!! We get denials from case management who don't get PPA on medicare 2ndary policies and we are non-par and it will have patient responsible, because the guidelines for par and non par are different.

PMRNC:
It depends on the contract, some managed care contracts will allow you to collect the copay meeting only the guideline that "Services were rendered" In most contracts I've seen it's specified.

shannon29073:
We are in network with all of the carriers. I will have to pull all of the carrier manuals that we have. Thanks for your help. There is a huge difference of opinion between my staff. Most say we provided the services we should at least be able to keep the copay. The rest feel that we didn't abide by our contract therefore we shouldn't even get to keep the copay.

Trying to find something "concrete"- one way or the other!!

Thanks Again! I am excited that I found you!

PMRNC:
Yes, you have to go through each contract to see what the rules are.
What I do with my clients is I actually go through all their par contracts and I use a single sheet form to list certain notes for each one so that I have a quick reference. 

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