The system has been asked to modify the program that controls Auto Contractual adjustments for any claim that is not the ORIGINAL claim. Currently, any downstream claims (advanced claims) will never create an auto contractual adjustment at the time of billing. The change will modify this slightly.
The modification follows this specific scenario.
- A patient is admitted as Private Pay, either with a Private Pay payor, or by leaving the patient insurance screen empty
- Charges are entered
- The account is billed
- The month is closed, preventing the claim being unbilled and re-claimed
After this, the user is notified of Insurance for this account.
- The user adds the insurance to the patients admit screen
- Advances the Primary Private Pay claim to a Primary Insurance claim
- Bills the Primary Insurance claim.
If the Private Pay billing profile was not set up with the Auto Contractual rule, and the new Primary Payor profile is set up with the Auto Contractual rule and Fee Tables, then this SECOND PRIMARY claim will contractualize even though it wasn’t the original billed claim.
This new enhancement will roll out some time in the next week or two.
If you have any questions about this new enhancement, please contact system support staff.