Wiki Copay myth?

[ajijon]

Hey all,

I wanted to ask for your opinion. I was told that as a participating provider when you submit the claim to an insurance without the copay payment applied you may get reimbursed more. Is this true or should the copay payment be applied before submitting the claim to the insurance company.


I would appreciate your input.

Thanks!

 

[marytwalsh]

Myth

MYTH -
Plus when you post the copay it does not appear on the claim

 

[ajijon]

It shows up as copay amount on paper claim right? what about eclaim? Even if the copay is applied to the account.

 

[terkim_98]

Electronic posting will only be concerned with the payment and adjustment of the charge. If the patient has already paid the copay the account will be zero, otherwise it will reflect the copay balance.

 

[lorrpb]

Box 29 is used to show what the primary payer paid when submitting to the secondary. It should not be used for patient payments, unless it's payer specific requirement. This is very clear in the NUCC instructions. Whether or not the pt made the copayment is irrelevant to what the payer pays. If you've been putting pt copays in box 29, that's why your payment has been reduced, because it's being interpreted as payment from a primary payer.

 

[MarcusM]

I never indicate on a claim what the patient pays. Just bill the usual and customary amount and the insurance processes based on the contractual allowables and pays either the lesser of the billed amount or the contracted allowable. If you are getting 100% of your billed amount, then you are undercharging for your work.