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mdunham
Premolar III

Tracking Insurance Payments and Adjustments by CONTRACT ALLOWANCE TABLE

Problem:  Insurance Income and Adjustment Reports by company cannot be correct for providers in which are contracted with Third-party Payers.  This is due to the fact that TPP's change clients or provider is cross networked.  

Suggestion;   Create Insurance payment and Insurance Adjustment Modifier codes that describe a payment made by the TPP or Ins company.   Create a monthly report that includes these modifier codes. When this is done the practice is better informed in respect to income and adjustments generated by CONTRACT.    SD would need then to correct the Default adjustment and Payment codes to be flexible per practice to avoid posting errors via e-posting service, etc.  

  Example:  2.02 Metlife payment, 50.19 MetLife Adjustment.   2.03 Connection Plan Payment, 50.20- Connection Adjustment ,2.04 Careington Payment 50.30 Careington Adjustment. etc. 

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doctom4300
Premolar III

Re: Tracking Insurance Payments and Adjustments by CONTRACT ALLOWANCE TABLE

I have never run these reports, but was wondering if you can choose which insurance companies to include when you run the report? If so, you could run the report for MetLife, and even though all insurance companies use the same code for adjustments, that report would only show MetLife adjustments.

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mdunham
Premolar III

Re: Tracking Insurance Payments and Adjustments by CONTRACT ALLOWANCE TABLE

I wish it were that simple.  However, when contracted with TPP, the report is useless, as the plans are not set up and cannot be set up as Careington/Connection/Dha/DBP etc, because they are only the leased network and do not receive claims.    The report currently asks for prompts such as Plan:XY thru Plans: xYZ, and would not provide accurate plan adjustments etc because an office could be cross networked.  

Also, if the plans numbers are not grouped together and are somewhat erratic in placement within the system, you would have to search the list for plans and not be able to correctly include all plans.  

Allowing the option of reports/adjustments/ production/income by Allowance table associated to plans will allow practices to obtain truer numbers by contractual agreement.  

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