ServiceXG Basics

Overpayment refund

After a claim or disability occurrence is adjusted, an amount due or overpayment could result. Review refunded money and the overpayment history, view the current balance, and enter refunded money from members or providers. Track overpayment refunds from disability or claims with the Overpayment refund report.

Go to: Home > Administration Processes > Claims Adjustments > Overpayment Refund

1. Enter who to associate the overpayment or refund to, the M—member, P—billing provider, or S—service provider.

   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 level and not the billing provider level. 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 the Update billing provider details, comments, and alerts topic.
2. Enter the required assigned payee’s ID number (member or provider ID).
   • If this is for a service provider, a window displays with available service providers associated to the billing provider. The selected service provider’s ID will automatically display in the Service Provider ID field. If you don’t select a service provider, the first available service provider’s ID is used.
3. Select or enter the Fund from the window that displays the available funds.

4. If there are any overpayments or refunds, a history displays along with the current balance.

Enter or update the refunded money received from members or providers

1. To add money received from members or providers for the amount they owe, type A at the Overpayment Refund select line.

   

2. Enter or update the refund information. To update existing refunds type the line number for the item to update (for example to update the check number, enter 3).
   • the Draft Identifies the banking arrangements and the check format for use within a checking account. for the fund
   • the Check Number for the received money and the Check Amount
   • the date you received the check at Check Date
   • At Action Date, press Enter to accept today’s date or enter a different date for the check transaction.

   • At Refund Type, enter the source for the money. Depending on your system setup enter P (billing provider), S (service provider), or M (member).

     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 level and not the billing provider level. 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 the Update billing provider details, comments, and alerts topic.
3. Enter C to continue and return to the overpayment refund screen where any added or updated refund amounts now show for the selected member or provider.
4. When you’re done adding or updating overpayments, enter F to save the changes.

Prior payment adjustments (PPAs)

Show claims where prior payment adjustments were taken for the selected payee. A prior payment adjustment made during claim entry automatically updates the file and shows as a positive amount.

1. Enter 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.—Prior Pay Adj at the select line on the Overpayment Refund screen.

   

2. Enter who the PPA adjustment applies to M—member, P—billing provider, or S—service provider.

   Note: Service Provider is a selection only if a system administration configuration (SAC) is 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.
3. All prior payment adjustments show for the selected member or provider. The claim type shows in Src (D—disability, blank—claims).

SEE ALSO