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Adjustment Settings for Secondary Payers

Overview

This article will give an overview explanation of the adjustment settings for secondary payers found in the Settings Module & the Payers Module.

Adjustment Settings in the Settings Module

General Settings for All Secondary & Non-Primary Payers 
  1. Go to Settings Module > Billing tab > 'Use these settings when a payer is the secondary payer'.

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  2. Columns:
    • 'Prior 3rd Party Payments' - This is any payment made by a payer, not a client, that has been applied to a bill line in Payments for a client and DOS.
    • 'Copays, Co-Ins. and Deduct' - This is the transaction type posted on a bill line.
    • 'Prior Adjustments' - This is the adjustment transaction type or custom writeoff.   
      • These are created in the Settings Module > Billing tab > Custom writeoff fields.  
      • The 'Prior Adjustments' column will include the custom writeoff fields only if in the Settings module > Billing tab > Custom Write-off fields > 'Counts as prior payment adj.' is set to YES. If 'Counts as prior payments adj.' is set to NO then the custom write-off will not be included in the 'Prior Adjustments' column.
    • 'Prior Discounts' - These are discounts that appear on a bill line when Expected Revenue is used.
       
  3. Rows:
    • 'Subtract these when computing invoice charge on claim:' - This setting will default to 'No' for all columns.  
      • 'No' will indicate that the charge amount in the Change Time window > Amounts tab is the same total DOS charge that will appear on a claims sent to a non-primary payer.  This is the same amount that was sent to the primary payer.  This is desired because Procentive will then subtract out the required COB information on the claim to balance it out, telling the non-primary payer what was charged to the primary payer (or any other prior payers) and what each payer processed on the COB (ie payment, adjustment, etc.). 
    • 'Add these when computing the prior payment:' - This setting will default to 'No' for all columns.
      • Changing any of these to 'Yes' would show an increase in your payment from the primary payer, which would be inaccurate and would result in the COB not balancing on the claim.  It would most likely lead to not getting any additional payment from the non-primary payer.
    • 'Subtract these when calculating the invoice charge:' - This is what appears in Procentive, ONLY in the invoice window as well as in the new bill line in the Payments Module for this next payer being billed.

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      • This screenshot indicates what you expect to be paid from the non-primary payer.  The amount that is actually sent on the invoice to the non-primary payer can be seen on the claim, as seen in the screenshot below.

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        • Columns 'Prior 3rd Party Payments and 'Prior Adjustments' default to 'Yes'.  This takes the total charge and subtracts out any payment, adjustment or custom writeoff that was applied to the prior bill line in Payments for this client and DOS.  This will show you what you can expect to be paid from the non-primary payer.  It will also give you a more accurate numbers in the Accounting Module > Billed in Period column and Adjustments column.  
          • If this is set to 'No', your total Billed in Period column amount would be the same as what was billed to the primary payer, overinflating the billing totals.  Overall Accounting Adjustments would be much larger since the non-primary payer will likely only pay the Patient Responsibility amount, assuming it is within the maximum allowed amount for that code and payer.
          • 'Prior Discounts' default to 'No'.
Payer Specific Settings
  1. Go to Payers Module > double-click on the payer > Rates tab > Rates subtab > 'Use these settings when a payer is the secondary payer'.

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  2. These settings will show as [default], meaning they default to the settings in the Settings Module > Billing tab, as shown above.  If you want any of these to be different than these default settings for the specific payer, you will change them here.
    • Note: not all the settings from the Settings Module > Billing tab can be changed to be payer specific.

Note: We do not advise changing these settings away from the default unless you have consulted with Procentive first.  After reading this article and testing your settings, if you have any additional questions, please send Procentive Support a Help ticket for further assistance.

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