Understanding Adjustment Types

This topic discusses the adjustment types available in the Claim Adjustments screen in Carrier Payments. Different adjustment types are available, depending on whether you are recording an underpayment or an overpayment. For information on using Carrier Payments, see Posting Internal Claim Transactions.

Underpayment Adjustment Types
Overpayment Adjustment Types

Underpayment Adjustment Types

Depending on the adjustment type you select, the status of an underpaid claim will be changed to Fully Paid, Underpaid, NonReceivable, Written Off, or Rejected. Keep this in mind when searching for claims you have adjusted. You cannot search for claims by adjustment type (for example, Biller Review).

The following table describes the underpayment adjustment types.

Adjustment Type	Description
Adjustment	Performs an adjustment similar to adjustments made in the Claim Detail window. The Total Remaining on the claim is adjusted off and the claim status is changed to Fully Paid. You can continue to edit the claim when using this adjustment type. Note: Using Adjustment --> Timely Filing helps you track late filing issues in your practice by making affected claims easier to locate in your reporting.
Bill to Insurance	Transfers the receivable amount entered to a secondary insurance carrier and creates a new claim. The receivable of the original line item is adjusted by the transfer amount and entered as the receivable for the line item on the new claim. The status of the original claim is set to Fully Paid.
Bill to Patient	Transfers the amount in the Remaining column from the carrier to the patient. The claim status is changed to Ready to Bill Patent. To bill the patient, print and mail the patient letter. For more information on printing patient letters, see Billing Patients.
Biller Review	Adds a marker to indicate that another biller needs to review the claim after the payment is applied. Your accounts receivable is not reduced when you select this adjustment type. The claim status is changed to Underpaid and/or NonReceivable and you cannot add any additional adjustments.
Rejection	Changes the line item status to Rejected if the payment amount is $0, or Underpaid if payment greater than $0 but less that the full amount was received. Refer to the rejection reasons on the EOB to select the correct Rejection type.
Write Off	Performs a write off to the line item similar to write offs in the Claim Detail window. Allows you to change the outstanding receivable. Changes the claim status to Written Off and you cannot add any additional adjustments. Note: If you would prefer the claim status to be Underpaid, rather than Written Off, use a Biller Review adjustment type instead.

Overpayment Adjustment Types

The following table describes the overpayment adjustment types.

Adjustment Type	Description
Adjustment	Performs an adjustment to the line item similar to adjustments made in the Claim Detail window. Allows you to change the outstanding receivable. Depending on the final outstanding receivable amount, the adjustment changes the claim status to Underpaid, Fully Paid, or Overpaid. Follow these guidelines when selecting an Adjustment type for an overpayment: Use Adjustment --> Keep Overpayment Balance to keep the overpaid amount and show the greater than expected payment on your reporting. If you use Adjustment --> Refund Overpayment Balance to Carrier you should generate the Billing Adjustments Report and select Refund Overpayment Balance to Carrier as the Adjustment Reason to list the refunds that need to be paid to the carrier. Issue a check to the carrier for the amount shown on the report. The amount you refund is written off your accounts receivable. If you use Adjustment --> Refund Overpayment Balance to Patient you should generate the Patient Refund Report to list the patients that are owed refunds.
Transfer Credit to Patient	Creates a credit on file in Front Office.

Adjustment Type

Description

Adjustment

Performs an adjustment to the line item similar to adjustments made in the Claim Detail window. Allows you to change the outstanding receivable. Depending on the final outstanding receivable amount, the adjustment changes the claim status to Underpaid, Fully Paid, or Overpaid.

Follow these guidelines when selecting an Adjustment type for an overpayment:

Use Adjustment --> Keep Overpayment Balance to keep the overpaid amount and show the greater than expected payment on your reporting.
If you use Adjustment --> Refund Overpayment Balance to Carrier you should generate the Billing Adjustments Report and select Refund Overpayment Balance to Carrier as the Adjustment Reason to list the refunds that need to be paid to the carrier. Issue a check to the carrier for the amount shown on the report. The amount you refund is written off your accounts receivable.
If you use Adjustment --> Refund Overpayment Balance to Patient you should generate the Patient Refund Report to list the patients that are owed refunds.

Transfer Credit to Patient

Creates a credit on file in Front Office.