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.