100: Payment made to Patient/Insured/Responsible party

Denial Occurrences:

• This denial occurs when the Assignment of Benefit (AOB) is not signed by the patient.
• This denial can also occur when the provider is out-of-network and the patient plan does cover out-of-network benefits.

On Call Scenario:
                                                                     Claim Paid to Patient
                                                                                      ↓
                                                             What is the processed & paid date?
                                                                                      ↓
                                                  What are the allowed amount, paid amount and
                                           patient responsibility (Coins, Deductible or Co-payment)?

                                                                                      ↓

                                    Verify sum of PA and Patient Responsibility(PTR) equals to AA,

                                            if not then probe the rep and get the correct information

                                                     Click here to validate payment information
                                                                                      ↓
                                                             Why was the claim paid to patient?
                                                                                      ↓
                                                               May I have the claim# & call ref#

Important Notes & Actions:

• Please take action as per your process update. Below actions can be different from your process update.
• If the claim is paid to the patient then the claim can directly bill to the patient.
• Do not bill this denial to the secondary or consecutive payer, this is the patient's responsibility.
• No need to ask for check details since it is not paid to the provider and cannot be tracked by the provider.
• Click here to go to Quiz

Prepare Notes:

Source of Status:

* Call Website EOB System

Clearing House Comment (Please make the changes if required):

Insurance Name:

*

Clearing House Name:

Insurance Phone#:

*

Rep Name:

*

Website Name:

*

Processed Date:

*

Paid Date:

*

Allowed Amount:

*

Paid Amount:

*

Deductible Amount:

*

Coinsurance:

*

Copayment:

*

Reason for paying the claim to patient:

*

Additional Comment:

Claim Number:

*

Call Reference#

*

Action:

* Claim released to patient Need client assistance



In the below box, final notes will be displayed once you click on Submit button and this box is editable, so you can make the changes as per the requirement

Note: We are not saving any of your inputs or notes in the backend