Intellect™
ELECTRONIC BILLING OF SECONDARY CLAIMS
(07/2013)
When billing the secondary payor, the claim level of the electronic claim requires the amount the primary carrier actually approved to be part of the electronic claim. If the Approved is the same as the Charges, the claim is rejected. Therefore, Intellect has an edit which catches this situation before the claim is submitted.
When primary payments are posted through Payment --►Auto Payment, Intellect updates the database with the actual approved amount from the Electronic Admittance Advise (ERA).
When posting payments manually through Payment --►Open Item, the focus stops at the ‘Approved’ column. The approved amount calculated at the time the charge was posted is displayed. If this is different than the actual approved amount on the Explanation of Benefits (EOB), the actual approved amount should be entered.
|
Example |
Charge |
Expected Approved * |
Actual Approved ** |
Submitted |
|
1 |
100.00 |
100.00 |
0.00 |
No |
|
2 |
100.00 |
100.00 |
100.00 |
No |
|
3 |
100.00 |
80.00 |
100.00 |
No |
|
|
|
|
|
|
|
4 |
100.00 |
80.00 |
0.00 |
Yes |
|
|
|
|
|
|
* Expected Approved: The approved amount captured at the time the charge was posted. If Pay Plans and Fee Schedules are not set up for the insurance, the amount of the charge is inserted into this field when the charge is posted. For more information about how approved amounts are calculated, refer to Approved Amounts in the online documentation.
** Actual Approved: The actual approved is either entered automatically when payments are posted through Payment --►Auto Payment or must be manually entered in the Approved column when posting payments through Payment --►Open Item.