How do I set a claim to balance to zero for overpayments due to bill rate increase on payor side? (FAQ)

Solution:

Scenario - Payor has retroactively paid claims with a higher bill rate but increase not reflected in the claim due to payor not advising, resulting in payments of higher values now reflecting as an overpayment.

You will need to revise the claim's bill value (Revise claim to reconcile with clearinghouse) on service lines to match the amount paid. No need to resend the claim, only revising to match the higher payment.

Notes:

• You can troubleshoot the issues explored in this article in your staging environment.
• If the issue is not resolved after going through the steps in this article, please search through other related Zendesk articles or have your super user submit a Zendesk ticket.
• For a full list of FAQs related to Claims, check out this section in Zendesk.