Provider Claim Summaries to Be Generated on All Adjustments

Currently, when a claim is adjusted and no additional payment is made, a Provider Claim Summary (PCS) is not generated. We are pleased to report that, beginning in November, a PCS will now be issued in all instances when a claim is adjusted.*

This enhancement is the result of feedback received from the provider community. Your comments helped make us aware of situations where our members could be responsible for deductible, coinsurance or non-covered services if claim adjustments resulted in patient/member liability changes. These instances were previously not communicated to the provider, as no PCS was issued.

Once the new functionality is implemented in November, you will be able to identify revised Patient Share amounts resulting from adjusted claims. This change should help avoid confusion on the part of our members, in addition to assisting your staff with patient account reconciliation.

* Exception: A PCS will not be generated in Request for Claim Refund (RFCR) situations.

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