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Independence, through written agreements with its participating providers,
may conduct provider credit balance audits. Credit balance audits are performed
by health insurance payers, or the payer's authorized agent, to identify and
resolve facility provider accounts that contain a credit balance. These
accounts may contain a credit balance for a number of reasons, including, but
not limited to, duplicate or similar claim payments, coordination of benefits
issues, workers' compensation coverage, automobile insurance coverage, or
misapplied contractual allowances.
If your facility is selected for a credit balance audit, you may be asked to
submit a credit balance report to Independence. A credit balance report should
include as many of the following data elements as possible:
- patient's full name
- patient's date of birth
- plan code
- Independence's certification number
- document control number (DCN) or claim number
- patient account number
- dates of service (both the admission and discharge dates)
- hospital department service (patient account financial class)
- diagnosis related grouper (DRG) (inpatient account)
- total charges
- patient payment
- total payment
- third-party payment
- total adjustment
- other adjustment
- deductions
- amount of credit balance
- aging buckets (e.g., 1 ? 30 days, 31 ? 60 days)
In addition to the above data elements, Independence may require view-only
access to the facility's patient accounting system and a copy of the facility's
allowance codes and patient accounting financial class.
Independence is committed to working with facilities in an attempt to
resolve credit balances in a quick and nonintrusive manner. Resolving credit
balances will benefit facilities through reconciliation of their accounts, in
addition to helping health care payers control premium costs for their
membership.
For additional information regarding credit balance audits, please refer to
your Managed Care Hospital Agreement and Independence Member Hospital
Agreement.
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