View the Reprice Comparison Results

The Reprice Comparison Results page displays expected reimbursement calculation results for an account, using the selected secondary payor profile terms. Optionally, it displays COB reimbursement amounts for the standard types of COB language.

Procedure

Access the Reprice Comparison page.
- Select Go To > Account Research > By Account Number. The Account Research by Account Number page opens.
- Type the account number and click Display Account. The Patient Account Audit page opens.
- Click Reprice Comparison. The Reprice Comparison page opens.
  Note: The Reprice Comparison button is not available if Coordination of Benefits (COB) is enabled for your facility and you are viewing a reprice summary for a secondary or tertiary payor.
Enter your selection criteria.
Select the reprice comparison result options:
- Click the Display Coordination of Benefits Comparison check box to display COB reimbursement amounts for the standard types of COB language.
- Click Product to compare results between insurance products, and select the product you want to compare reprice results against.
- Click Contract Profile to compare results between contract profiles, and select the contract profile to compare reprice results against.
Click Calculate to display the Reprice Comparison results.
- The Product / Contract Profile section shows the original expected reimbursement for the claim.
- The Alternate Product/ Contract Profile section shows the total expected secondary reimbursement if the claim was repriced using the alternate product or contract profile.
  Note: This amount is used to determine the expected COB payment for some types of COB language.
- The Coordination of Benefits Language (COB) section includes a table that shows the expected COB reimbursement for several standard types of COB language.
  - The Type column is an identifier to indicate the type of COB language that might be included in the contract.
  - The Description column summarizes several standard types of COB language that might be included in the contract.
  - The Calculation column displays the actual calculation used to derive the secondary calculated expected payment for the COB type.
  - The Secondary Calculated Expected Payment column indicates the additional amount you can expect from the secondary payor if your contract includes the COB language listed in the Description column.

The top section of this page is identical to the Reprice Comparison page. For more information refer to Calculate Reimbursement.

Field Descriptions

The following table describes the Reprice Comparison Results fields.

Field	Description
Charges
Billed Charges	The total charges incurred for the claim or set of claims that have been repriced
Non-Covered Charges	The amount of non-covered charges (not disallowed charges)
Product / Contract Profile– Displays the original expected reimbursement for the claim.
Product / Contract Profile	The name of the insurance product or contract profile.
Patient Liability	The amount the patient is responsible for. If an actual patient payment has been received, the amount of the payment displays. If no payment has been received, the message “Not Specified” displays.
Actual (Insurance) Payment	Total insurance payments for this account
Expected Insurance Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data, minus patient liability
Total Expected Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Alternate Product / Contract Profile – Displays the total expected secondary reimbursement if the claim was repriced using an alternate product or contract profile.
Alternate Product / Contract Profile	The name of the alternate insurance product or contract profile.
Total Expected Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data.
Coordination of Benefits Language (COB)
Type	Identifies the type of COB language that might be included in the contract.
Description	Describes the type of COB language that might be included in the contract.
Calculation	Displays the calculation used to derive the secondary calculated expected payment for the COB type.
Secondary Calculated Expected Payment	The additional amount you can expect from the secondary payor if your contract includes the COB language listed in the Description column