Switching: Claim Administration

When you receive a remittance from the medical aid with a negative balance, it means that the medical aid reversed a claim and will either reimburse that amount with the next payment or would have deducted the amount for codes that were incorrectly billed.

Example:

• To do a receipt for this payment, you need to create a medical aid debtor before you start with the receipt. See in this image below how you have to create a debtor (DEB82) and use the medical aid name as the name and surname of the debtor.

• After you've created the medical aid debtor, you can start with the receipt. You cannot do a receipt with a negative balance so you need to start the receipt with a zero amount.

• Do the receipt as normal, and where they reversed the claim, you have to allocate the negative amount as well. 

• After you've done the receipt as normal, the total amount available to allocate on the receipt will correspond with the total amount on the remittance.

• Now you need to allocate the amount to the Medical aid (DEB82) debtor that you've created.

• After you've allocated the amount to the medical aid debtor (DEB82), you should have a balance of R0.00 and you can post the account as usual. (This method will put that medical aid debtor (DEB82) in a credit of R1450.40)

Summary of DEB82:

• When the medical aid reimburses the credit with the next payment, you will use that Medical aid debtor again to deduct the amount from that remittance.

• Start the receipt with the correct balance of the remittance.

• The first debtor is the medical aid debtor (DEB82) from which you will take that credit amount.

• Then continue with the rest of the remittance.

• If the rest of the remittance balances correctly, you can post it as usual.