Referrals & posting payments
Posted: Mon Mar 23, 2015 10:25 am
Tufts Health Plan, when they deny a claim for lack of referral (CO165), post an adjustment for the entire amount of the claim. Now, after we get a referral, reprocess the claim and get paid, all payments show up bright yellow as overpaid.
We can either: Not post the initial denial and post only the payment OR delete the original denial when the payment comes through.
Either approach has its problems - In the first case, it is hard to tell that there was no payment for this claim and easy to miss the zero payment, and in the second, you lose the historical data.
What is the preferred way to handle this? It gets more complicated as different payers handle CO165's differently on the ERA. I would like to have a uniform approach, if possible.
We can either: Not post the initial denial and post only the payment OR delete the original denial when the payment comes through.
Either approach has its problems - In the first case, it is hard to tell that there was no payment for this claim and easy to miss the zero payment, and in the second, you lose the historical data.
What is the preferred way to handle this? It gets more complicated as different payers handle CO165's differently on the ERA. I would like to have a uniform approach, if possible.