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Insurance Adjustments

Insurance Adjustments

Add more insurance adjustment codes to be able to track the amount of adjustments per insurance company. With the ability to attach the claim to it.

1 Comment
Premolar III

You can manage this by creating modifier codes for the Insurance Payment. 

Example:  2.01=Connection Dental Payment

                 2.03=Delta Payment

                 2.04=Cigna Payment

I do suggest creating Insurance Payment codes names based upon the Contracted Allowance Agreement name.  In my example above,2.01; Connection is a third party payer, therefore all plans which have the Connection Allowance table attached would reference 2.01 for all payment received from that contracted Third party.    It is best to only make ONE modifier code for any Third Party Payer, as their client lists can change rapidly.  Companies may drop/ change TPP's as they wish.  Alternatively, your provider may drop or pickup other TPP's.   

Example:  Provider is Contracted with Connection and Careington TPP.  Metlife PDP plans paid on Connection Jan 1-March31st.  April 1st Metlife PDP plans drop Connection and now process claims via Careington.   

In an effort to monitor income based on those two agreements, you would need to post all Jan 1-March 31st payments on the Connection Modifier code, and all others on the Careington Modifier code.  

Additionally, I create Adjustment codes based upon contracted agreements so I am able to monitor adjustments/risk to practice based upon those agreements.  

If you are NOT contracted with ANY plans, the use of these modifier codes can also be beneficial to you. 

Insurance payment modifier codes will allow you to attach a claim, therefore closing the claim properly, which will also prompt to send any secondary.