ServiceXG Basics

Overpayment refund report

Track overpayments from either disability or healthcare claims with a report that can assist in monthly balancing. This report will indicate the action taken on overpaid accounts, as well as the cumulative balance.

Go to: Home > Displays, Data Preps, Reports > Claims Adjustments > Refund Report

1. Enter either I or A to set the report dates by I—issue date or A—action date.
2. Enter the From Date for the report.
3. Enter the Thru Date for the report.
4. At Totals Only:

   • Type Y-yes to have the report show only the balances.

     OR

   • Type N-no to show all transactions and the balances. The report will show each payee with transactions. The reference numbers, status codes, dates and amounts will show as well. Amounts overpaid to payees are represented as negatives, recovered monies are positives.

5. Enter the payees to include: M—members only, P—providers only, or B—include members and providers.

   Note: To track payments at the service provider, a system administration configuration (SAC) needs to be set to take the overpayment at the service provider and not the billing provider. Ideally when using this option, the billing provider shouldn’t have overpayments. Contact your Bridgeway representative to set or change SAC (System Administration Control) settings. Don't change SACs without first consulting Bridgeway as changing them can affect other functions and global system settings. To apply overpayments at the billing provider level for only specific billing providers, see Update billing provider details, comments, and alerts
6. Next, if you want to report on a single member or provider:
   • If you selected M, and want to report on a Single Member enter the member’s social security number.
   • If you selected P, and want to report on a specific billing provider enter the billing provider’s ID number in Single Provider.

   • If you selected P, and want to report on a specific service provider, enter the service provider’s ID number in Service Provider.

     OR

   • Press Enter to leave the field blank.
7. To include overpayments that have resolved to a zero balance, enter Y, or enter N to not include them.

8. At Include Released Claims, type Y to include released claims, N to not report released claims, or O to only report released claims (this will include zero balances).

9. To create a list of claim refnos once the report runs, enter a name for the list at List Name of Refnos to Create or press Enter to leave blank.
10. Determine if the report will include PPA A way to recover a previous overpayment by deducting the amount from a check issued to the same payee until the overpayment is recovered. This reduction has no impact on the benefit of a claim; the impact is on the amount of the check. amounts for: type D for disability, C for claims, or B to include both claims and disability prior payments.

11. Press Enter. If needed add a Fund and the Refund Type (the overpayment refund type) to report.

    Note: To add overpayment refund types go to Codes and Criteria >> Claims Processing >> Refund Types.

12. At Include Released Claims, type Y to include released claims, N to not report released claims, or O to only report released claims (this will include zero balances).

13. Enter C at the Select line to process the report. This process generates a physical print job per payee that is sent to the spooler. If the report is run for only one payee type, only one print job will be delivered to the spooler. See Print queue—Retrieve a print job.

    

SEE ALSO