Path: Smart Toolbar > Account button > Claims tab
Payers will, at times, reverse previous adjudications for numerous reasons (e.g. plan termed, duplicate charge, etc). To issue a refund or process a retraction, the amount to be refunded/retracted (e.g., overpayment, erroneous patient payment) MUST first be entered as a credit in the patient's account. If a refund is being issued as a result of a retraction, the original payment must be deleted from the corresponding claim to allow OP to record an available credit on a patient's account.
Process a Retraction
- Once you are able to determine the reason for the reversal, proceed to the specified Patient Account.
- Click on the Claims tab .
- Locate the claim associated with the retraction and click on the plus signto expand to view claim details, including prior payment lines.
- Click on the payment line that is being retracted and click on the Minus Void button at the top of the screen.
- Click Yes when prompted "The highlighted transaction is archived. Would you like to void it?"
|Note: A credit will now be issued for the specified patient. At this point, you will need to record a refund against this amount in the form of a check or account transfer if the amount is retracted on an ERA or EOB.|
- If the payer is taking all of the monies back from a previously paid claim, click on Recoup to remove all insurance payments and adjustments from the claim.
- Click OK to the pop up, "This action will recoup all insurance payments for the ENTIRE highlighted claim. Are you sure?"