Invalid Recoup

Error Level: Claim

Error Message: Invalid Recoup

Actions to Take: User should review the claim/status to make sure they are correct considering that this recoup was posted. 

  1. Click Resolve

  2. Review the previous payments for the claim in question either by looking at the listed payments or clicking the link for Claim # ______. Upon making the determination on the validity of the recoup, and whether the claim and status have been set correctly, the user can either choose to exclude this deposit claim, set the level/status differently, or ignore this error. 

About this Error: Sometimes a payer will send a payment and a recoup for that payment in the same ERA. In those instances, if the recoup was listed before the payment, the system would post the recoup first, then the payment. Because the payment would look like a full payment, the status/level would be set as if the line was paid even though the payment had already been recouped. This could cause the line to progress to the next payer or the patient!

To fix this, we have created a claim error that triggers when a recoup is being posted with no originating payment from the same payer. This will ‘hold’ this posting so that it can occur after the associated payment. The most you'll need to do is double-check the validity of the recoup and that the resulting claim level and status are what you'd want them to be-- if those values look good, you can ignore this error.