Custom tabs are used so agents can check printed bills, identify additional case details and also know the reason why a claim was denied.
- It’s important that you check the notes and/or memos at the same time you check any of these tabs before providing details to the patient.
There are several tabs but only the following are to be reviewed:
STATEMENT
This is where you will find out if a bill has been printed yet and what is the most recent cycle.
If there are multiple rows, it could mean that the patient has received more than 1 bill, and/or there might be information for multiple cases. Make sure you know which case you are reading.
There are also columns; make sure you read the following to help you understand what you need to tell your patient:
- STATEMENT DATE: Date when a bill was printed.
- DOS FROM / DOS TO: Date when the patient provided the sample.
- STATEMENT CYCLE: There are approximately 30 calendar days between one cycle and the other; Natera’s billing cycles can last between 3 and up to 6 months. Here you can find how many bills or letters have been printed.
- RELEASE TYPE: Reason why the bill was generated; due to denials, patient responsibility amounts, self-pay, etc.
- STATEMENT AMOUNT: Amount the bill was printed for. The only exception is when the Release Type is a PRESTATEMENT; then the amount only makes reference that this is not a bill but a letter.
- STATEMENT REF ID: Case number assigned to the row that you are looking at.
Before telling the patient how much they owe, check the Patient Total Responsibility on the Patient Tab AND always check for memos and notes!!!
A Secondary Insurance Update could be offered for most scenarios EXCEPT for OA100 check amounts.
If there’s NO information under the STATEMENT tab it means there’s no bill yet and therefore, NO PAYMENT CAN BE TAKEN. If the bill is self-pay it will take approximately 30 calendar days from DOS to generate a bill; if it was processed through the insurance remember it takes approximately 30-45 business days for a claim to be answered.
STATEMENT CYCLES AND RELEASE TYPES
Here’s a list of the possible combinations of Statement Cycles and Release Types and their meaning:
| STATEMENT CYCLE | RELEASE TYPE | MEANING | ACTIONS |
| PRESTMT 1 | IMMEDIATE | This is a letter sent to the patient advising them that we have incorrect or missing insurance details and advising them to contact us to update information.
This is not a bill yet so no payment can be taken |
If the patient wants to update their insurance information, follow the Insurance Update process and advise the insurance company will send an EOB when claim has been completed.
If patient wants to go self-pay, advise to wait for one more letter and at the 3rd billing cycle, a self-pay bill will be sent and until then patients can make payments |
| PRESTMT 2 | IMMEDIATE | Second letter sent to the patient letting them know we have incorrect or missing insurance details and advising patients to contact us to update information.
This is not a bill yet so no payment can be taken |
If the patient wants to update the insurance information, follow the Insurance Update process and advise the insurance company will send an EOB when claim has been completed.
If patient wants to go self-pay, advise to wait for the next billing cycle and a self-pay bill will be sent. Until then patients can make payments |
| STMT 1 | SELFPAY | This is the FIRST bill generated.
Proceed to attempt to take the payment and ONLY if needed, you can attempt to negotiate according to the Walkdown document. At this point, patients can choose to update the insurance details or proceed to make a payment for the discounted price. |
If patient wants to pay the self-pay price, process a payment as usual.
ONLY if requested by the patient, you can negotiate according to the Walkdown Send ZBAL / Courtesy exception escalation if needed Applies for Compassionate Care if requested If a patient wants to update the insurance information, follow the regular process and advise patients to wait for their EOB once the claim has been completed and disregard any bills that may get printed in the meantime. Remember we cannot stop bills from being printed while the update is in process. |
| STMT 2 | SELFPAY | Second bill was generated.
30 days after the first bill was printed, the price will increase to the full cash price. Proceed to attempt to take the payment and ONLY if needed, you can attempt to negotiate according to the Walkdown document. At this point, patients can choose to update the insurance details or proceed to make a payment for the discounted price. |
If a patient wants to pay the full cash price, process a payment as usual.
ONLY if requested by the patient, you can negotiate according to the Walkdown Send ZBAL / Courtesy exception escalation if needed Applies for Compassionate Care if requested If patient wants to update the insurance information, follow the regular process AND advised patients to wait for their EOB once the claim has been completed and disregard any bills that may get printed in the meantime. Remember we cannot stop bills from being printed while the update is in process. |
| STMT 3 | SELFPAY | Third that was generated
Still applies for the same full cash price as the 2nd bill. Proceed to attempt to take the payment and ONLY if necessary, you can attempt to negotiate according to the Walkdown document. At this point, patients are still able to choose to update the insurance details or proceed to make a payment for the discounted price. |
If patient wants to pay the full cash price, process a payment as usual.
ONLY if requested by the patient, you can negotiate according to your Walkdown document Send ZBAL / Courtesy exception escalations if needed Applies for Compassionate Care if requested If patient wants to update the insurance information, follow the regular process AND advised patients to wait for their EOB once the claim has been completed and disregard any bills that may get printed in the meantime. Remember we cannot stop bills from being printed while the update is in process. It may be possible that if after there’s no payment within the 3rd cycle the account can go to Collections. Make sure you make your patient aware of this. It may be necessary to check if the account has already a WODUNN code. If so, please remember you need to make sure you check the DOS is less than 180 days in order to complete an Insurance Update; otherwise, just proceed to take the payment and follow the WODUNN escalation. |
| STATEMENT CYCLE | RELEASE TYPE | MEANING | ACTIONS |
| PRESTMT 1 | PAID TO PATIENT | This is a letter sent to the patient letting them know their insurance company has issued an OA100 check meant to be paid to Natera and it reminds them that it needs to be sent/paid to us ASAP
This is NOT a bill yet |
Since it’s just a letter, no payment can be taken yet.
OA100 checks CANNOT be negotiated Even though you could see a very high amount, remember since it’s not a bill, this amount is not to be shared with the patient |
| STMT 1 | PAID TO PATIENT | First bill generated when there’s an OA100 check involved.
The amount will reflect the sum of the check and patient’s responsibility If they have a responsibility aside from what was paid by the insurance company, they will be billed as an ONN statement cycle. |
ALWAYS attempt to take a payment for the full amount under the STATEMENT AMOUNT column.
If the patient wants to negotiate, remember the check amount CANNOT be negotiated at all! ONLY the PR portion of the bill applies for Walkdown negotiation and/or Compassionate Care. ONLY for PR portions, send ZBAL / Courtesy exception escalation if needed Ask your CSS before if unsure. |
| STMT 2 | PAID TO PATIENT | Second bill generated when there’s an OA100 check involved.
The amount will reflect the sum of the check and patient’s responsibility Bill amount stays the same even after the first cycle has passed If they have a responsibility aside from what was paid by the insurance company, they will be billed as an OON statement cycle. |
ALWAYS attempt to take a payment for the full amount under the STATEMENT AMOUNT column.
If the patient wants to negotiate, remember the check amount CANNOT be negotiated at all! ONLY the PR portion of the bill applies for Walkdown negotiation and/or Compassionate Care. ONLY for PR portions, send ZBAL / Courtesy exception escalation if needed If in doubt, ask your CSS If the patient doesn’t pay within the 3rd cycle, the account WILL be sent to an external collections’ agency. Please make sure you review your memos and notes for any additional details. If the account is already in collections, the only action you can take is to provide them with the collection agency’s details |
| STATEMENT CYCLE | RELEASE TYPE | MEANING | ACTIONS |
| STMT 1 | SELFPAY | Patient doesn’t have an insurance plan or didn’t want to use it for billing purposes.
This is the first bill and therefore, it will apply for the discounted price of $249/$349 depending on the panel taken |
Attempt to take payment for the full amount and ONLY if the patient asks, you may negotiate according to the Walkdown
Send ZBAL / Courtesy exception escalation if needed Applies for Compassionate Care if requested In case the patient wants to send a claim, the Insurance Update process may be followed |
| STMT 2 up to STMT 5 | SELFPAY | This is the second bill and therefore, the amount will be the full cash price assigned to the panel taken | Attempt to take payment for the full cash price and ONLY if the patient asks, you may negotiate according to the Walkdown
Send ZBAL / Courtesy exception escalation if needed Applies for Compassionate Care if requested In case the patient wants to send a claim, the Insurance Update process may be followed |
| STATEMENT CYCLE | RELEASE TYPE | MEANING | ACTIONS |
| STMT 1 | NCS | Insurance denied the initial claim and Natera generated the first bill for the discounted price assigned to the panel taken. | If the patient doesn’t ask, limit yourself to take the payment for the full amount.
Only if the patient asks why a bill was sent even though it was processed through the insurance, you may need to explain the reason of the denial and make sure you position Natera’s discounted bill as a benefit that the patient can take advantage of Send ZBAL / Courtesy exception escalation if needed You can negotiate according to the Walkdown, Compassionate Care applies. |
| STMT 2 up to STMT 6 | NCS | Second bill, but now it has gone up to the full cash price | If the patient doesn’t ask, limit yourself to take the payment for the full amount.
Only if the patient asks why a bill was sent even though it was processed through the insurance, you may need to explain the reason of the denial and make sure you position Natera’s discounted bill as a benefit that the patient can take advantage of Send ZBAL / Courtesy exception escalation if needed You can negotiate according to the Walkdown; Compassionate Care applies. |
| STATEMENT CYCLE | RELEASE TYPE | MEANING | ACTIONS |
| STMT 1 up to STMT 5 | INN or REGULAR INN | Both Release Types mean that a claim was processed and completed through the insurance, and there is a Patient Responsibility. | It’s possible that the insurance made a partial payment but if there’s a bill with this Release Type it means there’s a portion of the total price of the test that’s the patient’s responsibility to pay.
Check the History Tab, click on the PI green lines and check the Reason Codes to make sure you understand where it comes from The usual Reason Codes are: PR1 – Deductible PR2 – Coinsurance PR3 – Copayment Attempt to take payment for the full amount and ONLY if the patient asks, you may negotiate according to the Walkdown Send ZBAL / Courtesy exception escalation if needed Applies for Compassionate Care if requested If the patient states their EOB says a different amount, advise them to send a copy of all of the EOB pages to: [email protected] so, we can confirm what’s the correct information |
| STATEMENT CYCLE | RELEASE TYPE | MEANING | ACTIONS |
| STMT 1 up to STMT 5 | OON | Patient has an insurance plan that’s not In Network with Natera.
Since there’s no contract between the two parties, the regular price for these bills will be $749, although it may be lower |
Attempt to take payment for the full amount and ONLY if the patient asks, you may negotiate according to the Walkdown document.
Send ZBAL / Courtesy exception escalation if needed Applies for Compassionate Care if requested If the patient states their EOB says a different amount, advise them to send a copy of all of the EOB pages to [email protected] so, we can confirm what’s the correct information. |
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Last update by: Claudia F (August 20, 2024)