Takeback Examples

Takeback Examples

Takeback Amount is Greater than Expected

A Takeback amount on the ERA may be higher than the expected amount due to:

  • Interest applied between the notice and Takeback.
  • Sequestration recalculations.
  • Rounding differences across Claim lines.
  • Retroactive Payer adjustments.
  1. Post the ERA as Received: Apply the full Takeback amount exactly as it appears on the ERA, including any Provider Level Adjustments, as an Insurance Payment (IP).
  2. Identify the Discrepancy: Compare the expected Takeback amount to the actual Takeback amount on the ERA.
  1. The difference represents an additional Takeback amount.
  1. Post the Difference as an Adjustment: Since posting the actual Takeback will create a false Balance, post a Credit Adjustment for the amount of the difference to offset the balance.

Example

Scenario: The ERA indicates that $133.66 is being taken back, but the Payer initially paid $133.29.

  1. Post the ERA as Received: Post $133.66.
  2. Identify the Discrepancy: The difference between the original Payment (133.29) and the Takeback ($134.66) is $1.37.
  3. Post the Difference as an Adjustment: Post an Adjustment of $1.37 to cancel out the balance due and restore the Claim Balance back to the original Charge amount.


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