Insurance Coordinators
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Secondary overpayments
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Secondary overpayments
Hello,
Occasionally we have secondary insurances (we are out of network with the exception of Medicaid) that essentially ignored our claim and primary insurance payment EOB and pay their full amount which results in an overpayment by the secondary and a credit on the patient’s account.
I don’t feel like it should be our responsibility to have to work hard to help the secondary to realize this (since we already did a good job with the first claim and EOB), but I don’t like having credits on a patient account because this will create more headaches and confusion for us and the patient down the road.
Is there a good way to have a quick, systematic approach for the office team to resolve this? Perhaps a templated letter that is quickly generated and sent to secondary for them to review payments? Any advice is appreciated.
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2 Replies
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I simply notify the plan via Electronic Attachment service, ( I use NEA) and keep a receipt. Perform my own Coordination of Benefits, and place a “insurance refund” on pts screen so that any credit would not be erroneously granted to patient by another unsuspecting staff member. When the plan recieves your notice via electronic attachment, they can then send you a request for refund. This suffices your notification if you are a contracted provider. If you are not contracted with plan you do not have to do anything, except hold refund ( insurance refund transaction code) in the event the plan requests a refund.
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This depends on what type of plan the patient has. If it is a self insured dental plan then the credit could be due to the patient. I would investigate the type of plan so you know who is due the refund.
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