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In each line information window, the adjudication date (same as EOB date) and the adjustment codes and amounts must be entered.
The adjustment codes may be printed on the EOB, but often they will only be listed as categories such as copay, co-insurance, deductible, contractual adjustment.
If this is the case, look up the appropriate code at WPC-EDI website.
The codes and the adjustment amounts must be entered to create the appropriate EDI records in the secondary claim.
Solution: If the batch to which the payment was posted is soft closed, use Batch Closing Override to modify the payment information and enter a zero if needed in either the Payment or Adjustment column.
If the batch is hard closed, void and clone the visit and convey the payment to the new ticket.
Otherwise, a Centricity Batching rejection will occur.
For CPS 06, from Registration, click on the “Insurance” tab, click on the Medicare carrier, in the “Medicare Secondary” section select the appropriate option in the drop-down field.
Problem: “Actual Allowed Amount is Missing from Procedure #…” – During payment entry, the Actual Allowed column in the “Transaction Distribution” window was not populated correctly.
Here are some common rejection scenarios and solutions: Problem: Non-Primary Medicare Policy Type is Required – The carrier needs to know why Medicare is secondary to another policy. Solution: For CPO-04, from “Patient Information,” on the “Patient” tab click on the “Medicare” secondary carrier then click on the “Details” button.
From the “Additional Policy Information” window go to the “Medicare Secondary” section and select the appropriate option in the drop-down field.
Health Systems has a Power Point presentation that can assist you in populating these fields correctly.