Monday, June 28, 2010

Claim processed as PR - 2 Coinsurance Amount

PR -  2  Coinsurance Amount

A provision in a member's coverage that limits the amount of coverage by the plan to a certain percentage, commonly 80 percent. Any additional costs are paid by the member out of pocket


A specified dollar amount that a member must pay out-of-pocket for a specified service at the time the service is rendered

Coinsurance amounts are generally 20% of the Medicare fee schedule. Physicians must collect the unmet coinsurance from the beneficiary. Consistently waiving the coinsurance may be interpreted as program abuse. If a beneficiary is unable to pay the coinsurance, the physician should ask him or herto sign a waiver that explains the financial hardship. If no waiver is signed, the beneficiary ’ s medical record should reflect normal and reasonable attempts to collect, before the charge is written off.

Action : 

1. We need to file the claim to secondary insurance
2. If there is no secondary insurance we can bill the patient.


A flat amount the member must pay before the insurer will make any benefit payments. The deductible is usually a set amount or percentage determined by the member’s contract and is set for a given period of time.

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