Wiki When to drop to PR when secondary payer processed to PR?

[yvette2002@msn.com]

I'm relatively new to Medical billing. I have a Medicare crossover claim here where they processed $25.94 to PR coinsurance but then Aetna secondary processed paid the $25.94 and put an additional $40 to PR copay. Do I bill the difference between $40 and $25.94 to the patient or is this an insurance overpayment? I don't understand this.

 

[vanessamoldovan]

I'm relatively new to Medical billing. I have a Medicare crossover claim here where they processed $25.94 to PR coinsurance but then Aetna secondary processed paid the $25.94 and put an additional $40 to PR copay. Do I bill the difference between $40 and $25.94 to the patient or is this an insurance overpayment? I don't understand this.

you would not apply the copay per the 2ndary EOB. The patient balance would be zero. Great question. Vanessa Moldovan

 

[thomas7331]

Agreed, if the secondary plan paid the entire balance that was due after Medicare, then the claim was paid in full.