Payments and Adjustments
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      PR Adjustments - Special Situation

      How to use PR Adjustments in EZClaim

      In previous versions of EZClaim, patient responsibility codes were exported as a single PR2, even if there were no PR2 codes adjudicated or multiple PR codes adjudicated.

      However, in 2021, certain payers, such as Medicaid, require the unbundling of PR codes in electronic secondary claims.

      To address this, a new solution was introduced in release 671, which allows for easy unbundling of PR codes during manual payment entry. 

      Solution

      • Added a payer option to Unbundle PR adjustments exported in Loop 2430
        Added a new service line level column called Reason Amount
        • Used to report dollar amount assigned by payer to each Reason code
        • Does not affect the service line balance

      How to use PR Adjustments with manual Payment Entry

      • Click Show Adj Reason Amount in Payment Entry

      • Fill in the amount assigned to each PR Reason in the Reason Amount column

      Note: The tracked PR Reason Amounts must equal the service line balance in order to unbundle. If not, EZClaim will bundle the PRs together.

      • Reason Amounts on CO, OA, and other adjustments have no effect.
      • Bill-To Payer must have the unbundled option checked in the Payer Library.

      UNBUNDLED secondary 837 generation

      BUNDLED secondary 837 generation for comparison