Claim paid and applied towards offset

Scenario Occurrences:

• This scenario occurs when insurance already paid an additional amount to the provider in the past and to cover that amount, they process and pay the current claim but do not release any payment. Instead, they ask to consider it from an additional amount paid in the past.

On Call Scenario:

                                                 Claim paid & applied towards offset
                                                                           ↓
                                                  May I get processed and paid date?
                                                                           ↓
                                        What are the allowed amount, paid amount and
                                patient responsibility (Coins, Deductible or Co-payment)?

                                        Click here to validate payment information
                                                                           ↓
                                  May I know the reason, why is it applied towards offset?
                                                                           ↓
                                  May I know to which patient is it applied towards offset?
                                                                           ↓
                                          May I know the patient account#, DOS & CPT?
                                                                           ↓
                                      Could you please fax the EOB? if not then mail it 
                                              or provide the source to get the EOB?
                                                                           ↓
                                                 May I know 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 you receive the EOB then you can note the account and send the EOB for posting.
• If you do not receive the EOB then you can note the account.
• Click here to go to Quiz

Prepare Notes:

Source of Status:

* Call Website EOB

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:

*

Is reason for applying towards offset available?:

* Yes No

Reason for applying towards offset:

*

Is patient information available to which offset applied?:

* Yes No

What is the patient information? (Account number, DOS and CPT):

*

Source to get EOB:

* Fax Mail Website

Website Name/Link:

*

Mailing Address:

*

EOB Available on Website:

* Yes No

Additional Comment:

Claim Number:

*

Call Reference#

*



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