Secondary Claims Billing, Revisted-from 2009.

[ClaimsConfusion]

Back in 2009 this was discussed (pasted below) but it doesn’t quite answer my question although it’s very close.  I’d just like to confirm that I am doing this ‘right’, and I’d like to stop my mind from spinning on about this.

Specifically, I use an online electronic processor/clearing house to create secondary HCFA forms. (AND I have only had one insurance company request a primary EOB, so I’m almost never sending in the primary EOBs.) In the section of the online HCFA claims “SECONDARY CLAIM: FILL IN INFORMATION FROM PRIMARY EOB/ERA HERE” I keep the same billed amount, $130 in box 1 'allowed amount'- even if the primary EOB reduces 'thier' allowed amount to say $90. 
Next box over is, “PRIMARY PAYER PAYMENT AMOUNT”, Here I put what they paid, say $80.
(Date, group code, and reason code, I understand.)
“Amount” is where I put the difference, so in this case $130-$80=$50 to the secondary insurance to pay.
So these numbers differ from the primary EOB.
Here PrimEOB might say 130, allowed 90, paid 80=10.
Am I doing this right, wrong? Confused…

Pay_My_Claims got close to my answer in this thread… http://www.medicalbillinglive.com/members/index.php?topic=613.15
 “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.”

[Michele]

IMO it appears you are doing it correctly.  You are showing the original charge, the amount allowed and the amount paid.  In our system we also have to indicate the primary contractual adjustment as well.

[ClaimsConfusion]

Michele-
Thanks for your reply, however, it makes it sound like i'm doing it wrong.
I'm putting the ALLOWED amount as the full $130 (even when the primEOB reduces it to 90). 
My boxes read: allowed, primary payor amount paid, and amount.
I always say the allowed amount is the full billed amount.
Should I be putting the reduced allowed amount given by the primary payor?

When the primary EOB Says: billed 130, allowed 90, paid 80=10 patient responcibilty.
I enter in allowed $130, minus paid $80,=$50 amount due.

(I wish this wasn't so confusing, Thanks for the help, I need it!)

[PMRNC]

I always say the allowed amount is the full billed amount.

It Sounds like you are doing this correctly.. the BILLED amount $130 is NOT the allowable of $90.  In your system you are "adjusting" off the $40  so your still billing the actual charge of $130.   YOU always want to bill the ACTUAL charge, not the allowable. This is done for a variety of reasons, one being that it helps carriers keep an accurate analysis of charges to figure out fee schedules and U&C, and two, it gives the practice a TRUE picture of accounting, for example if the practice wants to see what's being written off by particular carrier, they can run this report and get an accurate amount of adjustments per procedure and per carrier. That comes in handy for negotiating new contracts, credentialing with others and opting out of others.
 

When the primary EOB Says: billed 130, allowed 90, paid 80=10 patient responcibilty.
I enter in allowed $130, minus paid $80,=$50 amount due.

That sounds right.

Now see that sounds more accurate. But your missing the PPO ADJ = $40   

[ClaimsConfusion]

Thank you both so much for the help!
I'll keep doing what i've been doing then, sounds like the right path to me...
Thanks again.