Why is the Insurance portion estimate on Ledger not showing the correct amount

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Kenneth Rhodes

August 25, 2014 14:45

Why is the Insurance portion estimate on Ledger not showing the correct amount?

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  Kenneth Rhodes August 25, 2014 15:51

  The office notices that the insurance portion that shows on the ledger is incorrect. There are a couple of things to check for this.

  
  1. Make sure that there are no procedures on the ledger that are not attached to a claim. The insurance estimate will not consider insurance payments for procedures that are not attached to claims if those procedures were posted to the ledger prior to the current date.

  
  2. If there are un-attached procedures on the ledger, verify that the patient has an insurance plan attached and that the effective date of that plan is prior to the date of the procedures on the ledger. Then create the claims for the unattached procedures.

  
  3. If there are no un- attached procedures on the ledger, have the office verify the fee schedules for the insurance plan that is attached to the patient and ensure that the fees are correct. Finally, you will want to verify that the provider is in contract with the insurance company. If any of these connections is not made, the insurance portion can be incorrect.

  4. Check the coverage tables and make sure that the code ranges that are listed have a Capital "D" in front of the code number. One office had changed the code ranges and put in a small letter "d" in front of the codes. The result was that the system did not recognize the code ranges and  there was not an insurance portion calculated even though everything else was correct. 

  

  5. The benefits are utilized for the year or a value of 0.00 is present in one of the benefit fields. For example, if 0.00 is entered in the Annual Family Benefit Maximum, no estimated insurance payment will be calculated. If the field is blank, the program will rely on the Annual individual Benefit Maximum. 

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  Reagan Bryant March 09, 2018 21:02

  If you have checked all of these, and the ledger is still not recognizing the adjustments, what should we do?

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  Chris Christley March 09, 2018 23:00

  The only other thing I can think of that you might be running into is to check if the procedures have the bill to insurance turned off. You can check this by clicking on the procedure in the ledger or in the progress notes. If you go through these steps and it's still not helping then please call into support Mon-Fri 6:00 AM to 5:00 PM MST (855)232-9493 Opt. 2.

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  Reagan Bryant March 12, 2018 13:10

  The only amount that is showing the patient owes is the amount that we adjust off for contractual agreement with the insurance.  It's very frustrating, because then they get a bill in the meantime, and it looks like they will owe that balance when they do not.  

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  Chris Christley March 14, 2018 21:40

  If you have checked all of the steps listed above and your still not getting a write-off then I would call support Mon-Fri 6:00 AM to 5:00 PM MST (855)232-9493 Opt. 2.

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  deirdre werth May 07, 2018 21:11

  Check here...

  User accounts----Fees----- make sure that each insurance that has been entered has a check mark next to it.  This must be done in all user accounts. 

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  Richard Yu September 04, 2018 17:17

  Apparently, if your Insurance Payment has a check mark next to "(v) Additional payment(s) expected later from insurance", an estimated value for Insurance Portion is calculated.  Uncheck the box and the correct expected amount is calculated.  Why it does that is something the developers should probably address.

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