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primary paid more than secondary allowed amount
As title defines..

If secondary allowed amount is less than primary allowed amount, then secondary insurance wil deny claim as primary paid more than secondary allowed amount.

For example: member has two insurance policy active on date of service. Billed amount is $100.00. primary processed and allowed $80.00 as patient out of pocket. now claim was filed to secondary and secondary allowed amount is $60.00, then secondary will deny the claim as primary paid max. then $20 is provider adjustment and $ 80 is patient responsibility.


In this case we need to check whether secondary allowed amount is less than primary allowed amount or not and also check who is responsible for remaining balance; patient or provider.
if patient?
bill the patient
if provider?
request for provider adjustment.

Question:

(If primary allowed 100% and processed towards patient responsibility as out of pocket. secondary is medicaid. what we will do? let me know in this comments section below.)


Notes:
Insurance name. claim denied as primary paid max. claim number. denial date. primary allowed amount. primary processed and paid. Secondary allowed amount, which is less than primary allowed amount. patient responsibility is $0. remaining balance is provider adjustment. hence requested for adjustment.

Here is the playlist of denial management:
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