medical billing, Account receivables.
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Question / Problem
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how to resolve the claim, where the payments were issued to the patients?
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Solution
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When ever a Payer issues the payments to the Patients/members, there few check that you need to run, before you can fight with the insurance: 1.check if the assignment of benefits is checked, regardless of the type of form that you are using to bill, like CMS1500 or UB 04. - If the AOB is checked, as to release payments to provider, and the provider is Par with the carrier, you might want to know the reason, in issuing the payment to the patient.
- If the AOB, is left blank and you are the par provider, then also in most of the possible cases, insurances process the payments to the respective providers, however, as the claims are processed by an electronic systems in most of the cases, there are possibilities that the payment might be released to the patient. in such cases, recommended course of action is to check the claims payment information via call or online, and Bill the patient for the appropriate allowed amounts.
2. If the AOB is Checked and if the payment is still issued to the patient, check if you are a par provider, - IF you are a non -par provider, regardless of the AOB being checked or not,most of all (or) if any payments were processed will be issued to the patients, and in this case, you might want to bill the claims to the patient for the TC $ amt or only the allowed amounts
- Here in this case claims will be processed using UCR, Usual Customary and reasonable rates for the services.
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Applies to |
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Medical Billing
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Rank It |
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