Secondary Payer Allows/Pays more than the Primary Payer

Secondary Payer Allows/Pays more than the Primary Payer

Sometimes the Secondary Payer allows more than the Primary Payer allowed.

This most often occurs when the Patient has a private insurance versus a group insurance for the secondary.

  • The Secondary Payment is more than the balance.
  • Posting the Secondary Payment will leave a credit.

Scenarios

If the Secondary Payer paid as Primary in error, the over payment should be refunded.

If the Secondary Payer has verified that this Payment is correct because of a higher allowed amount, you can reverse a Primary adjustment, and post the Secondary Payment.

Reverse the Primary Adjustment/Post Secondary Payment

Reverse the Primary Adjustment for the same amount as the credit would be if the the Secondary Payment was posted.

  • The object is to have a balance of zero when finished.


Example:

  • Charge Amount: $250
  • Primary Payment: $150
  • Primary Allowed: $175
  • Primary CO45 Adjustment: $75
  • Primary PR: $25
  • Balance is $25

  • The Secondary Pays
  • Secondary Payment: $50 (There is a balance of $25)
  • Secondary Allowed: $200 ($25 more than the Primary Allowed)
  • Balance would be -$25 if posted.

Reverse the Adjustment and Post the Payment

Use Post Expert:

  • If the Patient ID is populated, tab.
  • If blank, find the Patient or enter the Encounter number preceded by an e (e1234).
  • Select the line item where the adjustment needs to be reversed.

  • Enter Transaction Code: IP
  • Amount: 50.00
  • Tab

  • Enter another Transaction Code: CO45.
  • Amount: -25.00 (negative) (Enter the amount that shows as the balance at the top of the Posting screen.)
  • Tab (Balance should be $0.00)
  • Select Save [F2].






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