Account Categories

Account categories help you create worklists for specific types of accounts you want to research. The account categories you can search by for your worklist include the following:

  • Suspected Overpayments – A suspected overpayment occurs when the actual payment is greater than the expected payment, and the write-off amount is less than the expected discount.
  • Suspected Underpayments – Suspected underpayment refers to the situation in which the actual payment is less than the expected payment and the actual discount is greater than the expected discount.
  • Payment Received – A payment received is any insurance payment that is made. An account in the Payment Received category might also qualify for any another account category except No Payment Received.
  • No Payment Received – No payment received refers to the situation in which no insurance payment is made.
  • Potential Denials – Potential denials refers to the situation in which the first payment transaction code has no dollar amount.
  • Paid Correctly – Paid correctly refers to the situation in which there is no difference between the actual and expected discounts.
  • Unusual Accounts – Unusual account refers to situations in which conflicting conditions such as the following exist:
    • Both the actual payment and actual adjustment are less than expected.
    • Both the actual payment and actual adjustment are greater than expected; for example, a $1000 claim in which the actual payment is $700 and the actual discount is $500, rather than $300.
    • The expected payment is greater than five times the billed charges (indicative of a gross error).

These conditions most often are the result of either:

  • Posting errors on the part of the business office. In this case the account representative alerts the business office, to correct the error and remove the unusual category.
  • Transaction mapping errors in which a payment or adjustment transaction code is not mapped to the proper category (like insurance payment, insurance adjustment, write-off). In this case, the account representative re-maps the transaction code to the correct category to remove the unusual category.