How to Handle an Insurance Overpayment

Many times, I appreciate the thinking that Dentrix Ascend does to make my work more accurate. Automatically posting xrays to the ledger or allowing me to choose any filling procedure code when treatment planning and correcting it to the correct tooth/surface are wonderful features. However, when the system won't let me post an insurance payment because it sees that the procedure has already been paid for - that can feel like I'm stuck. Just in case you run into this too, here are a set of instructions you can use. Here are the situations you might need to use this:

Secondary insurance overpays
Primary insurance overpays - The original charge was posted at $0, and an unexpected payment is received from insurance

Note: We recommend using the Guarantor view in the ledger for efficiency.

If a patient has dual coverage, the office can collect from the insurance up to the billed amount before applying any write off. If the combined payments from primary and secondary insurance exceed the charge, the difference should be entered as an insurance over payment refund.

Step 1: Enter a $0 payment to lock in the insurance adjustment

If there will still be a write off in addition to the overpayment, enter a $0 insurance payment with just the adjustments and mark the additional payment checkbox.

Step 2: Enter the insurance payment and in the same screen, enter the Insurance overpayment refund as the adjustment type.

If there are no write off adjustments, adjust the adjustment amounts down to 0 and select Offsetting from the Insurance Adjustment drop down menu. Select Insurance Over-pmt Refund from the Adjustment type. The amount from the insurance payment not applied to procedures should be reflected in the amount box associated with the adjustments.

Now, the adjustment will be entered in the ledger. You can then send a refund check for the excess amount to the insurance company.

In situations where you are using a Type 2 NPI where the location is your claim provider, this is the billing provider on the claim, you will also need to move the money from this location billing provider to the correct dentist. By moving this money, the doctors will be paid correctly. To move this money, you will want to use pairs of adjustments for each provider.

To move the production to the right provider, use a charge adjustment that impacts production – in our case, we selected the Transfer Charge Balance.