Payments > Insurance Payments

1500 CMC form

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PMRNC:
Is it an "edit"? or was this just something they said was not "advisable"?  what happens if you put the payment?? Is this for NY? I am in NY and bill a variety of BCBS  (Empire, WNY, ...) and I've always posted my payments.

Michele:
It was our local BCBS.  They said that it 'messed up' their processing system.  Personally, I think they have other issues with their processing system.  I wonder if the higher ups know what they tell people at these seminars.

Michele

PMRNC:
Not meaning to sound like I'm beating a dead horse..but ok.. what happens if you do put the payment on the claim form. I ask because I'm in NY too and I've never had a claim rejected over that.

Michele:
Well, we actually submit electronically to that company and our electronic software doesn't include the patient payment info on claims.  It only includes payment info when submitting secondary claims.  However, we are in the process of switching to Xena and I'm not sure if that will change.  We have never gotten a rejection for it, nor have we heard of anyone else getting one, but I'm not sure we've ever submitted a claim showing a patient payment. I still remember when they told us.  Our jaws were hanging down.  How can showing that a patient with a $20 copay, making a $20 payment mess up your processing system?????

I knew when I put it that it would stir something up.  I just wanted to show that sometimes insurance carriers request things that don't make sense.  Messes with people like us who keep all things in order!

Michele

Pay_My_Claims:
It has NEVER messed up the billing for me and I have been doing NC BCBS for years. If you look at the CMS-1500 and they are processing the claims, they are not pulling "amount due" they look at the total charges, and pay according to their contracted fee. This is why some patients get refunds because providers may collect the wrong amount up front. When billing 2ndary they want the EOB to see what was paid by the primary to do that reduction from what they allow and what they pay..this is why sometimes you can have a secondary payment come in and it pays more than what the balance is. They are not looking at that column. NC medicaid prime example we can't put on the claim the balance, we can only put on the claim the cost share when a Medicare HMO is primary, and those claims can only be done paper.

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