Remits
This adjustment code indicates a contractual obligation write-off.
What is CO 45?
This part of Medicare covers outpatient and physician services.
What is Medicare Part B?
Before issuing a refund, this must be validated and documented.
What is the overpayment?
These are payments received but not yet applied to a specific account or claim.
What are undistributed payments?
Insurance overpayments must be returned within this timeframe once identified.
What is per Managed Care Refund Policies by payer?
This code indicates the patient’s deductible responsibility.
What is PR 1?
When Medicare is primary and forwards a claim to secondary insurance, this is known as this coordination process.
What is COB crossover?
This should be verified before refunding to ensure the payment was not already recouped on a future remit.
What is prior takeback activity?
This should be reviewed first when resolving an undistributed insurance payment.
What is the remittance advice?
This law requires healthcare providers to report and return identified overpayments to federal payers within 60 days.
What is the Affordable Care Act 60-Day Rule?
This denial code often signals non-covered charges.
What is CO 96?
This determines whether Medicare is primary or secondary when a patient has employer group coverage.
What is the Medicare Secondary Payer (MSP) rule?
When a payer offsets a future payment instead of requesting a check, this action is called a ______.
What is a recoupment or offset?
Failure to resolve undistributed payments timely can impact this financial reporting metric.
What is accounts receivable accuracy?
Before issuing a refund for a discovered overpayment, this step ensures you are compliant with all payer and federal requirements.
What is verifying the root cause and documentation?
This process allows Medicare to automatically forward claims to a secondary payer.
What is a crossover claim?
This state agency administers Illinois Medicaid benefits.
What is the Illinois Department of Healthcare and Family Services?
Refunding a payer without confirming COB sequencing could result in this unintended balance shifting to the patient.
What is an improper patient balance?
This electronic payment format often includes trace numbers that help match funds to remits.
What is an ERA (835 file)?
Refunding an overpayment without first checking COB sequencing may violate this principle.
What is payer of last resort or proper sequencing rule?
This is the first thing you should verify when a recoupment appears on a remit without prior notice.
What is the original overpayment and claim history?
Wisconsin Medicaid provider information and claim tools are accessed through this secure online portal.
What is ForwardHealth Portal?
Failing to return identified overpayments within required timeframes could trigger this federal liability under the False Claims Act.
What is a reverse false claim?
When payment amount does not match expected allowed amounts, this should be reviewed before applying funds.
What is the payer contract or fee schedule?
Overpayments discovered from retroactive adjustments require this review step before issuing a refund.
What is determining the correct responsible payer?