Remember, each test has one or more CPT codes that compose it, and you will need to read them through the History Tab to better understand the different stages of a case.
Whenever a claim is processed, CPT codes will get an individual answer. You will be able to identify payments from the Insurance or from the Patient, test’s Full List Price, and if Natera has to absorb or write off any amount.
CPT codes are unique to the insurance billed and are only created when we submit an insurance claim. For Self-Pay patients, we don’t have CPT codes
ALWAYS CLICK ON THE “DETAIL” AND “ALL ITEMS” CHECKMARKS AND CLICK ON RELOAD TO GET ACCESS TO ALL INFORMATION. This will give you a full perspective of the patient’s case(s). You will see different columns; pay attention to the following:
CODE: CPT code you are interpreting, who’s answering to it (PI= insurance or PP=patient) and write off reasons.
PMT SOURCE: When you see P is Patient and I is Insurance
SERVICE DATE: Date of Service / Date the insurance answered or a patient paid
CHARGE AMOUNT: Full List Price
PAID / APPLIED: How much the insurance or a patient paid and any amount written off by Natera.
Also, there are 3 types of rows: Black, Green and Red
Black rows represent a CPT code.
Double click on it and you will be able to see which ICD10 code was assigned to the test of which that CPT code is part of and also on the right bottom corner you will be able to see to which insurance was sent the claim to and on which date.
Green rows are answers or payments.
If the row has a PI code it means that you are looking at an answer from the insurance.
If there’s an amount on the PAID/APPLIED column it means the insurance paid partially or completely for the claim.
If the PAID/APPLIED column is at 0.00, double click on it to check why the insurance didn’t pay; it could be because they denied or because the patient still has a responsibility such as deductible, coinsurance, etc. This will be represented by Reason Codes
This is one of the things you would check if the patient is asking where her bill is coming from.
Red rows are written off amounts.
Even though there’s a Full List Price for each test, remember there’s a contracted amount with insurance companies and that would be the maximum amount a bill can be; so, after the claim has been processed, the difference between the contracted amount and the Full List Price will be written off. Also, there will be amounts written off due to a special price that was quoted and ZBal’d; Compassionate Care write offs; because of Medicaid, etc
There are several write off reason and you might receive calls from patients asking if they have pending bills. The account may show $0.00 but please ALWAYS MAKE SURE you review the written off amounts and look for any WODUNN code. This means too many bills were printed and the patient didn’t pay; so Natera stopped printing bills but the patient STILL owes.
If there is an amount added to the patient’s balance, but the EOB says “adjusted” and the WO has not been done, send a Supervisor Escalation ticket through Syncro CRM, so the WO can be properly added. CSS ONLY: Send an email to “Laura Cobb” to have the WO added to the patient’s account.
Last update by: Claudia F (October 2, 2024)