Friday, June 25, 2010

BOX 29: AMOUNT PAID - secondary claim field

Attach the third party Explanation of Benefits (EOB)
for all claims involving a third party when balance billing
secondary after you have received payment or denial from
the primary health plan

If payment was made, you must enter the amount
of the insurance payment in Box 29, as well as attach
the third party Explanation of Benefits (EOB).

In order for the claims payment system to properly
distribute third party payments, only those line items
paid by the third party can be billed on the same claim

Those charges that have been denied by the insurer,
where no third party payment was made, must be
billed on a separate claim form, and you must include
the third party Explanation of Benefits (EOB).

Do not enter the Medicare payment in Box 29 if you
are billing for Medicare coinsurance or deductible

Do not enter the member’s anticipated copay amount. It will be
automatically deducted in the claims process.

Box 24F: Charges must equal the allowed amount that you and the
insurance company agreed to, as shown on insurance company’s
Explanation of Benefits (EOB).

Box 28: Enter the total charges. This must equal the total of the
individual line item charges in 24F.

Box 29: Enter the amount paid by insurance company/third party. The
third party amount must equal the actual third party payment, plus any
withheld amount shown on the insurance company’s Explanation of
Benefits. You must enter this amount on the claim form, and you must
attach the Explanation of Benefits.

Box 30: Enter balance due. This can not exceed the member
responsibility shown on the Explanation of Benefits

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