Per treatment line in the declaration, you can see what is reimbursed, what is charged to the patient, and what has been rejected entirely.
Tip: Always check the return code per treatment line before taking action. This tells you whether the rejection is justified and which next step makes the most sense.
How do I interpret the insurer's assessment?
Payt breaks down the total declaration amount into three columns:
Column | What does this mean? |
To health insurer | This portion is reimbursed by the insurer directly to the practice. |
To patient | This portion has been rejected by the insurer. The patient will receive an invoice for this amount. |
Rejected | This portion is not reimbursed and will not be invoiced to the patient, unless you choose to do so yourself. |
Insurers support their assessment with return codes. You can view the return code per treatment line and see what it means by hovering over it with your mouse.
Is the reason for rejection unclear, or do you suspect the assessment is incorrect? Contact the relevant insurer for further clarification.
What are my options?
Depending on the situation and the practice's decision, there are three possible next steps.
Invoice the patient for the rejected amount
Do you agree with the rejection and want to charge the rejected amount to the patient?
Tick the rejected treatment lines.
Select 'Create invoice'.
Review the overview of what will be invoiced.
Select 'Create invoice' again to finalise the invoice.
Resubmit the declaration
Do you disagree with the rejection and want to resubmit the declaration, with or without changes? Read how this works: How do I edit and resubmit a declaration in Payt?
Take no action / accept the rejection
Do you agree with the rejection and do not want to charge the patient? You can mark the declaration as 'Processed'. This is only possible once an invoice has been created for the treatment lines that the insurer has reimbursed.