Resubmit a portion of a previous claim

[jsugal]

Hi Gavin, It's Constance G.

I hope all is well. I have a question. I would like to resubmit a portion of a claim that wasn't paid and keep the same claim#. I noticed that a 96372 (admin injection) wasn't paid on a claim. The other parts of the claim were paid correctly. I went to the patient's case, deleted the adjustments and unchecked the "Apply payments to charges box" for all Ins Co. so the charge would " go back into Insurance" and the charge line turn black.
I then went to the Claim Manager and pulled up the claim. Under transactions, I removed the portions of the claim that were paid correctly. (I know that if I split a claim it creates a new claim # for the split portion and I didn't want that). After I changed the claim status to "Ready to send" the portion of the claim that I wanted to rebill submitted just fine. I did however notice that after I created claims for my other patients today, Medisoft also created a new claim for the portion of the claim that was paid correctly. I had to go back to claim Manager for that patient and change the status of the newly created claim to Done. Here are my questions? Doesn't it make sense to rebill a portion of a claim using the same claim number to cause less confusion for the Ins company (that is what I was told)? Is there an easier way to rebill a portion of a claim and keep the same claim number? Thanks for the information!

[Gavin Walker]

While it is possible to do corrected claims, Medisoft does not handle that very well. Instead I recommend you send a replacement claim. To do this, make all the changes to the claim so that it would be correct if you were sending the claim new today. Then go into Claims Management and edit the claim on the Carrier 1 tab enter 7 (for replacement) in Frequency Type.

[toniseven]

In my experience if you're rebilling part of an EDI claim you need to submit the claim number from the original EOB that paid the other transactions or processed them and didn't pay them. It is not illegal to rebill what has been paid.

When you don't include claim number that is on the eob, they are going to process it as previously processed and call it a duplicate. Be sure to include a resubmission code with the claim number in the case. Create the claim from Transaction entry window and then remove the resubmission code and the claim number and save it. I like to put it in the description line next to the 1st transaction that I am rebilling or in final draft with a note in the description line that says to see final draft. "Rbld 4/1.CFD"

This is not the claim number from medisoft. This is the claim number that the insurance assigns your EOB when it pays it or processes it

Sometimes with auto accidents or work comp injuries when you biill on paper you can rebill without that prior claim number from the EOB and it's perfectly fine to rebill the complete visit. These are usually processed by an individual and you can write a note on the paper claim and ask them to please reprocess it with explanation. "Chart note edit" for example.

Unfortunately you can't simply resend unpaid transactions