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Wednesday, July 14, 2010

Insurance denial and action for-PI 100- Payment made to patient/insured/responsible party

PI 100    Payment made to patient/insured/responsible party.

Reason : AMOUNT PAID TO THE SUBSCRIBER

Action :     This rejection indicates that the claim has been paid to the patient/subscriber. Normally, the claim is paid to the patient if our providers are non-participating with the carrier (BCBS, HMO’s and some commercials). If you find that amount has been paid to the patient, highlight the issue so that action is taken to make providers participating.  In such cases the patient has to be billed.


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