Provider Level Adjustments FAQs

Why do some payments have the Provider Adjustments field and some payments don't?

Provider-level adjustments are not shown on the Insurance Payment and ERA screens if there are no provider-level adjustments on the ERA.

Why does the EOB show a Provider Level Adjustment of -$50 but the ERA shows as $50 on the payment screen?

The provider adjustment amount is shown and calculated using the opposite sign that the payer sent (for example, if the payer sent a provider adjustment of $-50.00, this would increase the payment amount, so we will show it as a positive amount so that the amounts are easier to read).

Can I manually add a Provider Level Adjustment to a payment?

Yes, users are able to manually add provider level adjustments to EOBs. 

Visit our Add a Provider Level Adjustment Manually on an EOB Help Article for detailed steps on how to manually add Provider Level Adjustments.

Sometimes the system automatically associates a Provider Level Adjustment with a claim, when does this happen?

When provider level adjustments are added to the payment, if the reference identification of the adjustment is the same as, starts with, or ends with the TCN of any claim paid on the payment, then the system shall automatically associate the adjustment with a claim note.

Also, When a provider level adjustment is added to the payment, and the adjustment reason code is L6 (Interest Owed), then the system will automatically associate the adjustment with all claims on the payment that have Interest reported.

Can I remove a Provider Level Adjustment from a payment?

Users can remove a provider level adjustment. A removed adjustment will be marked as deleted and will not show on the payment after it has been saved.  It will also not be included in the Provider Adjustments total shown on the main summary screen. 

Can I bring back a removed Provider Level Adjustment?

Yes, Users have the ability to unmark the Remove button from a removed adjustment as long as the payment has not been applied yet.

Why can't I disassociate a claim from a Provider Level Adjustment?

If an adjustment is associated with a claim note, users are allowed to disassociate the adjustment from the claim note if they have permission to delete the claim note. Once the adjustment is disassociated, it will delete the claim note when the payment is saved and the adjustment will no longer show as associated with the claim note.

What happens to the Provider Level Adjustment claim notes if I delete the check?

If a check is deleted, any claim notes associated with the Provider Level Adjustment on the check will also be deleted!

Can I apply a Provider Level Adjustment to a claim balance?

Yes, if your workflow requires you to apply a provider adjustment to a claim, you can do so by entering the amount manually into the Apply to Claim Balance column. Visit our Associating Claims to Provider Level Adjustments Help Article for more info.  Please note that applying a provider adjustment to a claim balance will appear as an applied amount in reports, not as a provider adjustment.  

  1. You can also turn on the Payment Setting for User to "Automatically post Interest amounts as payments, which will reduce the claim balance owed to subsequent payers and to the patient?" so that any interest amounts linked to claims can be applied to the claim and posted as a payment. Please visit our Configure Payment Settings for User Help Article for more information on turning this setting on.