Processing an Insurance Retraction, Takeback, or Recoupment

Version 14.8
Path: Smart Toolbar > Account button

Overview

In some cases, insurance companies will take money back on claims that they have partially or fully paid to a provider, due to, but not limited to the following:

  • Paid in Error
  • Benefits were retro-terminated
  • Additional information requested

Insurance payment retractions can be handled by the payer in one of two ways indicated below.

Processing Retractions

Scenario 1

  1. Open Account from the Smart Tool bar.

  1. Search for the patient the insurance is taking money .
  2. If the money is not sitting as an Insurance Credit on the account, Open the Claims tab .
    (if there is insurance credit already on the child's account, skip to Step 6).
  3. Click on the claim that money is being retracted and click on Recoup button to delete the corresponding insurance money.
  4. Clicking on Recoup will remove all corresponding Insurance payments and adjustments and create an Insurance credit on the Credits tab of the Patients Account.
  5. If the insurance is requesting a check back for the recoupment click on Credits tab.
  6. Click on Add Refund button.
  7. Select Check as the refund method from the drop down.
  8. Record the amount that you are issuing back to the payer.
  9. Enter the refund check information in the Note field, for your records.
  10. Fill out the rest of the form as necessary.

  1. Click Save/Close when completed.

Scenario 2

The payer can enter the retraction on an EOB with payments for other patients, then reduce the check by the amount of the retraction. If this is the case, follow these steps:

  1. Open the child's account that the money is being recouped from. If the original payment is already applied to a claim and not yet entered as an insurance credit, see Un-applying a retracted insurance payment.
  2. The original payment being retracted needs to be in the Patient's Account as an insurance credit.
  3. When you receive the EOB with the retraction, open the Patient's Account for a patient that is being paid on the EOB.
  4. Open the Credits tab on the Patient's Account.
  5. Click on the Add Credit button.
  6. Click the button next to the Pay method field and select Insurance Transfer as your payment method.
  7. Select the Debit Patient search to choose the patient to debit insurance credits from.
  8. Enter the details of this transfer in the Note field. Details should include EOB number, a brief explanation of why this child received an Insurance Transfer.
  9. Once the credit is entered, you can apply the credit as a Payer Credit pay method to the claim paid on the EOB.