Incorrect Procedures on Claim

If you create a claim that contains incorrect procedure codes and have not sent it:

  1. Delete the Claim.
  2. Edit or delete the procedures.
  3. Recreate claim, then send it again.

If you create a claim that contains incorrect procedure codes, send it, and then realize the error or the insurance company denies the claim:

  1. First make a Commlog entry in the account explaining why payment denied.
  2. Open the claim and change its status to Waiting to Send.
  3. Delete the claim.
  4. Edit or delete the procedures.
  5. Recreate claim, then send it again.

If an incorrect procedure is submitted to insurance, insurance pays and check is created, then insurance company requests refund:

  1. Open the claim.
  2. Select the procedure(s), then click Supplemental in the Enter Payment area.
  3. Enter a negative insurance payment (refund), then click OK.
  4. If a check needs to be written from the practice to the insurance company, write the check, but leave the entry out of the deposit if using a Deposit Slip.
  5. If the insurance company is subtracting payment from a check for other patients:
    1. Add an Adjustment to the patient's account. The amount should equal the fee charged minus the write-off (e.g. patient portion).
    2. When that bulk check that includes the negative payment is created, the amount will be correct. Deposit as normal.
    3. Do not change the write-off (if any) on incorrect procedure(s).
    4. Leave the date as today's date to preserve the record.
    5. The incorrect procedure should stay on record. Select the procedures, add a note that it was not done, and check the HideGraphics box.

    The reason the incorrect procedure needs to stay on record is that paperwork has been submitted to the insurance company and money has exchanged hands. Just removing it makes it harder to explain in the account and makes your reports incorrect. If you must leave the incorrect procedure because of a claim, just add and predate the correct procedure code after you have followed the steps above. Send the claim again as needed.

If you just need to change a procedure code and there is no claim attached, click Change on the Procedure Info window.

If an incorrect procedure is submitted to insurance, insurance pays and requests a corrected claim:

  1. Commlog or notate on the claim that a corrected claim is necessary.
  2. For the incorrect procedures on the original claim, create an adjustment to adjust off the procedure amount. This will zero out the procedure fee.
  3. Chart the correct procedures for the original date of service.
  4. Create a new claim with the corrected procedures and service dates and send to insurance.
  5. We recommend contacting insurance to discuss any potential refunds.