Wiki Overpayment

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martin, GA
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I have a question that i really hope someone could help me with.
What do you in the case that a patient has a primary and secondary and the secondary allows more than the primary so the account now looks like an overpayment. I do know that as long as your contracted with both then it would not be a true credit back to the insurance (secondary), but what do you do in the case that the secondary sends for ex 45.00 to pt resp is the pt supposed to pay that? Are we supposed to just reverse the primary payers adjustements? Im so confused and i have a lot of accounts like this, i hope what i said made since?

Here is an ex:
Bcbs (primary)
allow>106
pd>>>>84.84
pt resp>>21.20 (co-ins)

aetna (secondary)
allow>165.34
pd:>>>>35.50
pt resp>>45.00 (copay)

so with the info mentioned above in the system when its posted it looks like a credit of $14.30. What am i supposed to do with the pt resp of 45.00 for the secondary insurance??????? Helppppppp!!!!!!!!!!!!
 
Contracts can be confusing when there are 2 carriers and they overlap. So using your example:

Total Charges Are $150.00
Blue Cross Allowed $106.00
Blue Cross Paid $ 84.80
-----------------------------------
Leaving for Copay $21.20

2nd Aetna Allows $165.34
And Pays $35.50
Stating Copay $45.00

In this case you are allows to keep the full payment from both Aetna and Blue Cross. The total payment does not exceed billed amount. You have a contract with both so there is no true overpayment. However, you would not be able to bill the patient for the $45.00 that Aetna states because your contract with Blue Cross was met leaving -0- due from the patient (The $21.20 was satisfied by the $35.50 payment from Aetna).

So...

* Total payments of $84.80 and $35.50 do not exceed bill charges.
* There is no overpayment, just need to correct the previous adjustment to allow for Aetna Additional payment
* Total payments are inline with both of your contracts
* Blue Cross contractual allowed of $106.00 prohibits you from billing the $45.00 copay by Aetna
 
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