How Andre Deals with Insurance That Takes from One Claims for a Recoup on Another in Eaglesoft
There are times when an Insurance Carrier will recoup a previous Claim Adjudication payment from a totally different patients’ payment. On the EOB it shows that they are paying for a service but then show a $0 payment because they are taking away money from a previous EOB. Typically, you’ll see a message like: “a reduction has taken place due to an overpayment on a prior claim”.
Example: Payment of $100 made to Patient A. XYZ Insurance says the money was not due, so they are “taking it back” and giving it to Patient B.
Start with:
1) Create a new Adjustment Type (List>general Setup>Adjustments) called “Overpayment Recovery” that impacts Collections.
2) Create a new Payment Type called “Ins Overpay Recovery”; Payment Prompt “number”; Currency Type “Check” and include on Primary Deposit
Next:
1) In the account that they “took” the "Overpayment Recovery" from, do a Debit (increase) Adjustment using the “Overpayment Recovery Adjustment” Adjustment type for (example) $100. Enter a Note using Patient’s ID Number whose money is reallocated to (DON'T USE PATIENT NAMES). Example: “Overpayment Recovery Reconciliation to #12345”.
Now that Account balance has increased by $100 (essentially removing a payment that was “taken back”). Distributed to the Service that this was for. This will also create a credit of $100 on your Collection reports removing it from the Provider who was initially paid for this service.
2) Close the claim of the Patients who the "Overpayment Recovery" payment will be reallocated to moving the responsibility for the balance to the Account.
3) In the account that they applied the "Overpayment Recovery" to do a Credit (decrease) “Overpayment Recovery Adjustment” adjustment for $100. This Adjustment should Impact Collections. Enter a Note using Patient IDs (DON'T USE NAMES). Example: “Overpayment Recovery Reconciliation from #12345”. Now the balance of that Account has decreased by $100 (mimicking the payment that was “recovered”). This will debit the $100 credit previously created on your Collection reports zeroing it out. And will reallocate collection dollars to the Provider for this claim.
4) If there is an amount still to be paid, post an Account Payment using the Ins Overpay Recovery Payment Type allocating it to the Line-Item Service.
Not perfect but will reconcile the balances.
DISCLAIMER:
This is a resource guide and all decisions on each dental office setup should remain the sole decision of the dentist/owner of the practice. Eaglesoft is a registered trademark of Patterson Dental Company. All other software or products mentioned are the property of their respective owners. Although Andre Shirdan was an employee of Patterson Dental, he is not associated with Eaglesoft or Patterson Dental Company or endorsed by Patterson or any other Company Mentioned in this blog
