Fees on Claims

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5 comments

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    Kenneth Rhodes

    The fees that are listed on the claim have always been the office usual and customary fees that are found in the fee schedule attached to the rendering provider. That has not changed to the best of my knowledge.  The Insurance plan fees are used to determine the estimated Insurance payment, the write off, and the patient portion of that payment. 

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    Deanna King
    We have found that that is in fact not the case, Kenneth. The fees associated with the insurance are the fees that show up on the claim. They are not the office UCR fees but definitely should be.
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    Kenneth Rhodes

    Thank you for your response. As you noted above, the office UCR fee "definitely should be" the fee that is shown on claims submitted to the insurance company. I have been testing this on my test accounts and the UCR fee has been the fee attached to the claims each time. Do you have an example claim that shows the insurance fee instead of the office UCR fee that you can send me. If the system is creating claims with the insurance fee instead of the UCR fee then we need to investigate this behavior to determine what is causing this.

    Thank you for your input and suggestions. 

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    Sonya Graves

    I was hoping to see more info on this subject, as this is exactly what is happening to our claims. Add the correct UCR is attached to the providers. 

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    Greg Quandt

    Hi Sonya,
    Is the procedure fee in the ledger correct? What fee schedule is attached to the Location? This is under Settings and Location info on the left.

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