Are claims Assigned, Non-Assigned or Complimentary?
Assigned claims:
The insurance pays you.
BILLED TO:
HCFA form is sent to the primary insurance.
PAYMENTS:
The responsibility should be to the primary insurance and the payment will
be made against the primary insurance. Any balance not paid by the primary should be moved to
the secondary or patient to allow for further billing. An invoice or HCFA will be sent during the
next billing cycle.
Non-Assigned claims:
The insurance pays the patient, then the patient pays you.
BILLED TO:
HCFA form is sent to the primary insurance and an invoice is sent to the patient.
PAYMENTS:
In the payment screen, the responsibility should be to the party making the payment, with the
balance being placed in the responsibility column of the appropriate party. If either party pays
the full amount, the claim is closed and no further billing will take place.
Complimentary claims:
The patient pays you, then you send a claim to the insurance for the patient.
BILLED TO:
Invoice is sent to the patient.
PAYMENTS:
Responsibility is to the primary insurance. The payment is entered on the patient line.
This will show an open amount against the primary and a credit to the patient when the payment is
made. After the payment in full by the patient, a HCFA form will be sent to the primary in the
next billing cycle.
Note:
Assignment is determined on the patient insurance card as well as on the order/claim. If you enter an order for a patient with an assignment value of "A", the order will be assigned. The assignment value may be changed on individual orders/claims and may not reflect the default that you had entered on the patients insurance card.