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The Importance of Patient Responsibility - a podcast. (Picture of robot)

Judy the numbers juggler explains to Simon the robot that:

  • TPL claims require the "patient responsibility" amount (field 30 on the CMS-1500 form)
  • Edit 165 denies the claim otherwise.
  • The patient responsibility is the total of: deductible + coinsurance + copay.
  • Medicaid pays the lesser of: patient responsibility or [Medicaid allowed minus the other carrier's paid amount], unless the provider has accepted payment in full.

Listen to this podcast (3 min.) 

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Last modified: Wednesday, August 15, 2018, 3:19 PM