eClaims - Why is the Patient Receiving the Insurance Payment and not the Office?

The most common reason for insurance payments being sent to the patient or subscriber, rather than to the office, is the use of the 'Signature on File' checkbox in the associated guarantor (Primary/Secondary) tab in the patient record of the Patients ability. This checkbox is the indicator to the payer that the subscriber assigns benefits to the office. Lack of this indicator on eClaims means to the insurance company that no such permission has been given.

Checking this box will resolve the issue for future eClaims, but will not have any impact on claims that have already been paid. Payment for services will have to be recouped from the guarantor for claims that have already been processed without the guarantor 'Signature on File' indicator enabled.

If it is the policy of the office to receive benefit assignment from all insurance subscribers, contact MacPractice support at 877-220-8418, for an EDI support specialist to enable the override in the eClaim template. This will ensure that assignment of benefits by the insured is indicated on all electronic claims, regardless of whether the indicator is checked in the Patients ability.

If 'Signature on File' is checked in the guarantor tab of the subscriber, yet the insurance company sent the payment to the subscriber, another possibility would be the accept assignment status on the claim.

Click the link for an explanation of the purpose of accepting assignment status on claims.

Click the link for an explanation of how to indicate 'Accept Assignment' within MacPractice.

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