Medicare always sends sequestration amounts as CO-253 on ERAs, and if a payer does not know how to send the sequestration amount automatically through an ERA message, it must be added manually to the adjusted column.
Adjustments sent with an “OA” group code are not included into claim balancing and therefore, this amount is not included in the insurance payment table. You will add the OA-253 amount to the amount in the Adjusted column of each service line (when applicable, of course) so that the remaining balance matches the patient responsibility.
For example, if the copay amount is $20 and the OA-253 amount is $1.25, the Balance will be $21.25 when the ERA comes in. The Adjustment column should be changed so that the $1.25 is included in the adjustment amount rather than passed along to the patient. Once this is done, the balance for the patient should be $20, not $21.25.
Comments
0 comments
Please sign in to leave a comment.