Why Insurance Balances Might Be negative
The goal of every ERA posting is to get the insurance balance to $0.
A negative balance can occur for several reasons:
1. Posting a Secondary ERA Response to a Primary Claim
Sometimes a secondary payer sends a status that indicates they processed it as the primary. Patient Studio will automatically attach it to the primary claim, even though it belongs on the secondary claim.
Fix: Unhook it from the primary claim and link it to the secondary claim. See how to link claims.
2. Manually Hooking a Secondary Claim Response to the Primary Claim
You may have manually attached a secondary response to the wrong claim.
Fix: Unhook it from the primary claim and link it to the secondary claim. See how to link claims.
3. An ERA Was Previously Posted in Error
It’s possible an ERA was matched and posted to this claim by mistake.
Fix: Confirm that all previously posted ERAs are correct. If one was posted in error, navigate to the original EOB and unpost it.
4. A Missing or Incorrect posted Reversal
Reversals need to be posted before a new payer response is posted. If this is the second (or later) response from the payer, make sure a reversal was correctly posted for each prior response.
Fix: Review reversals and confirm each was handled properly. Learn more about reversals.
5. The Negative Balance Is Correct
In some cases, the negative balance is valid and means you owe the insurance company money.
Common scenarios include:
After the claim was sent, the units were reduced. The payer’s response will include the original amount, creating an overpayment. Posting with a negative balance is correct.
With Medicare, a patient may have two secondary payers without realizing it. If both pay, it creates an overpayment and negative balance.
If you’re unsure why a negative balance occurred, review the ERA history for the claim and confirm all postings, reversals, and claim links are accurate.