Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

February 2018

Changes to Negative Balance and Refund Processes


To facilitate more timely and efficient recovery of claim overpayment amounts, Harvard Pilgrim is updating some of our negative balance and refund check processes for our commercial, Medicare Enhance, and Medicare Supplement members. Effective Feb. 1, 2018, we will begin moving some outstanding negative balances from a provider group/payee with no claims processing to another group/payee within the same provider organization (with the same TIN) that frequently has claims paid. By doing so, Harvard Pilgrim will deduct the negative balance amount from the other group’s claims paid amount.

New negative balance information will be included in the summary field on your explanations of payment (EOPs) and in the 835 provider level adjustment segments. Additionally, to make negative balance and refund information more easily accessible for our providers, Harvard Pilgrim has created two new reports — the Negative Balance Report and the Refund Report — both of which are downloadable as Excel files and are available via the Provider Analytics tool in HPHConnect.

Negative Balance Report
The new Negative Balance Report identifies claims associated with a negative balance, and records negative balance transfers from one payee entity to another. You can run the report for each payee in your provider organization using the date range that you select, and the report will include the provider name, address, TIN, and Harvard Pilgrim payee, as well as the following for claims associated with a negative balance:

  • Claim number
  • Patient account number
  • Harvard Pilgrim rendering provider ID
  • Member name and ID
  • Date of service
  • The reason the claim was adjusted and adjustment amount
  • Offset amount
  • The payment number associated with the claim adjustment
  • The cumulative negative balance amount

Refund Report
The refund report identifies claims associated with a refund check sent by a provider and processed by Harvard Pilgrim. The report identifies when a full or partial refund was returned by a provider, as well as:

  • Payee number (Harvard Pilgrim-assigned provider ID for the provider payment address)
  • Payment number
  • The check number and dollar amount of the refund check Harvard Pilgrim received from the provider
  • The amount accepted on this remittance (Note: one refund check may be split among multiple payments)
  • The Harvard Pilgrim claim number/s that the refund was applied to
  • The member number or numbers of the Harvard Pilgrim members involved
  • The patient account access number
  • The date of service of the claim
  • The amount of the refund check that was applied to the claim being referenced
  • The amount of the refund check being returned to the provider, if any
  • The balance still due after the refund check was applied to the claim
  • More information
To assist you in using these reports, Harvard Pilgrim has created a Negative Balance Report User Guide and Refund Report User Guide. In addition, we have created this document on how to read the 835 provider level adjustments.

For any further questions on running these reports, please contact Harvard Pilgrim’s Provider eBusiness Services at 800-708-4414, or by email at Provider_eBusiness_Services@harvardpilgrim.org. Also, If you do not currently have an HPHConnect account, we encourage you to sign up by clicking on the registration page in the HPHConnect section of Harvard Pilgrim’s provider website and following the instructions.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

Changes to Negative Balance and Refund Processes

Maximum Dosages for Medical Drugs

Reminder: Prior Authorization for Genetic Testing

Saheli Boston Can Help Meet the Needs of South Asian Patients

CLINICIAN CORNER

Prior Authorization for Diabetes Management Devices

Coverage of Exondys 51 with Prior Authorization

PCP Cardiac Medication Adherence Report

Member Blood Pressure Quiz

Endoscopic Sinus Surgeries Medical Review Criteria Updates

Lyme/Tick-Borne Diseases: Use of Parenteral Antibiotics Criteria

P&T Committee Meeting Update

Specialty Pharmacy Update

Members’ Rights and Responsibilities

HEDIS Spotlight: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET)

OFFICE ASSISTANT

Reminder: Use the Correct Form for Provider Changes for Quicker Service

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator