Prepayments missing from HCFA 1500 form

billing
question

(Sherwin Gaddis) #21

I am thinking along the same lines. I am reading and searching the code to see where the payerSequence() is used before implementing the conditional. I am glad you tested and it worked. I will test now and report back.

That worked… Thanks for the assistance.


(Sherwin Gaddis) #22

@sjpadgett
I am sad to report this was not the win I thought it was going to be. Changing this puts a the copay on each page of the claim. So, I have asked the billing department what is the condition under which the prepayment needs to show in box .

The issue we were having before has to do with prepayments that are applied to the invoice after the date of payment. Here is a ledger page

I applied the prepayment of $1460 to ID#5859 and it does not reflect on the claim. See image below and attachment. It should be reflected in item 29 of claim.


(Jerry P) #23

Hmm, I see. So I would assume that the payment would need to go on the 1500 page that the encounter payment is applied against or if lucky, the last page. Do they use MBO?
@stephenwaite In your experience, how often are patient payments (not copays) applied against primary insurance? Would this be something that needs to go into code base?


(Sherwin Gaddis) #24

This is for a practice that is in the Cayman Island. They don’t use clearinghouses there. The claim goes direct to the payer. The pay model is different than US. They make me think of Concierge service here in the US.


(Jerry P) #25

Or perhaps a Health Savings Account (HSA). That was how I looked at it when I fixed the prepayments in Patient Ledger. That may be a feature worthwhile adding to billing.


(Stephen Waite) #26

hi Sherwin. I’d be glad to help if possible. Could you help me understand the problem? You’d like to print claim forms for people who made prepayments who do not have primary insurance?


(Sherwin Gaddis) #27

That is correct. What billing needs is the prepayment to show on the claim form. The insurance company is requesting this information to be on the printed claim.

If you could tell me where to begin, that would narrow down the work.


(Jerry P) #28

Hi Stephen, These folks make pre payments against future procedures and when the procedure is billed, prepayments are posted against balance. Then a claim is submitted to Primary provider for the balance.

  • Problem is with 1500 we don’t allow box 29 to be populated with patient payments made against Primary.
  • Even if this is fixed, at what point i.e when is box 29 populated. Every page, last page or page that include encounter being billed e.t.c.
    I think this sums it up. At least my understanding. Sherwin was to find out when box 29 needed to be populated on form run.

(Sherwin Gaddis) #29

@sjpadgett
Thanks for that recap. It is very accurate. However, I am unable to get a coherent answer from the biller that I can rely. I asked the question but it seems there is a communication gap.

This is what she originally wrote to me.

Kindly note that it is not fixed as I applied the prepayment of $1460 to ID#5859 Brita- Lynn Gill and it does not reflect on the claim. See image below and attachment. It should be reflected in item 29 of claim.

But what is now happening is that the copay paid is being shown on all pages of the claim. This provides incorrect information to the insurance provider as the total seen on both pages will be collated as the patient’s total payment. For example in the file 2018-11-02-1314-batch, $130.75 is seen on both pages which would mean that the patient paid $261.15 but they actually paid $130.75.

As I explained to you, the issue we were having before has to do with prepayments that are applied to the invoice after the date of payment.

This is the screenshot that was sent with this message

What questions should I ask the biller?


(Stephen Waite) #30

ok, thanks guys, think it’s normal to sum up the charges and payments on the last page of a muti-page claim and put continued in box 28 on prior pages, NUCC doesn’t have a firm answer, http://www.nucc.org/index.php/1500-claim-form-mainmenu-35/1500-instructions-mainmenu-42


(Jerry P) #31

This is a problem for me. What payment? This would be much easier to understand if we had the actual 1500 in question. The ledger doesn’t tell the story of the claim itself. You may send to us if can’t display here. But if the numbers are correct and it is now just an issue of placement on the form then, I think Stephen gave us the answer.