Problem with Secondary Claims

mbpros · Post by **mbpros** » Mon Sep 11, 2023 11:31 am

So I'm having trouble with one payer for secondary claims. An allowed amount was applied to deductible. But the CAS segment has PR2 listed and it should be PR1 for deductible...and thus the payer is denying: CAS*PR*2*77~ is what appears.

I correctly posted the $77 as the deductible in Medisoft, but the IGuide apparently is placing everything as a PR 2 and not as PR1. How can this be fixed?

Thanks,
Steve

Post by **Gavin Walker** » Fri Sep 15, 2023 2:23 pm

Hi Steve, check your transaction type for your deductible in Medisoft. It should be type deductible. If not, then you'll need to change it and then run the Repair Payment Cross Reference repair in MediUtils then check the FixPax log for any missing transaction codes.

mbpros · Post by **mbpros** » Sun Oct 15, 2023 12:12 am

Hey, Gavin: So I just tested another. Deductible is set to Deductible Type. I ran Fix Payment References in MediUtils. In the new example $59 was allowed and applied to the deductible...but it still appears on the secondary claim as: CAS*PR*2*59.

It should be PR*1, not PR*2. Could it be a flaw with the iGuide?? Payer is denying the claim when we send the deductible amount as a coinsurance or copay...and they will not accept secondary claims on paper.

Thanks,
Steve

Post by **Gavin Walker** » Fri Oct 20, 2023 8:16 am

Normally deductibles are not applied. Maybe that is the problem.