Wiki Secondary has higher allowable than Primary

[Cher91600]

UHC is the primary on this claim, with BC/BS as secondary. UHC's allowable amount is lower than BC/BS. So here is the breakdown

UHC Allowed Paid BCBS Allowed Paid
Code 1: $ 70.57 $55.54 Code 1: $ 88.49 $ 0
Code 2: $ 9.89 $ 9.89 Code 2: $ 13.59 $ 3.70
Pt. Resp: $ 15.00 Pt. Resp: $ 21.62

Do we accept the Primary Insurance Adjustment & apply the $3.70 towards the initial patient balance of $15 or do we shift the allowable amount to the secondary for the Code 2 payment, but leave the balance due at $15 for the copay on code 1?

Thank you for any guidance that may be offered.

 

[Herbie Lorona]

My suggestion would be to check with them to see exactly how they processed line one first and why they didn't pay anything. If they say they applied the $15.00 that was left from primary to the pts copay as well then you would bill the pt for the $15.00 copay and put the $3.70 towards the second cpt code.