Patient Responsibility Inconsistent

Error Level: Claim

Error Message: Patient Responsibility:  The patient responsibility amount of <ERA Amount> is different than the remaining balance of <Claim Balance> on the claim.

Actions to Take: If you've received this error, you likely want to compare the "Patient Responsibility" amount found on the human readable ERA with the outstanding balance on the claim.  Many times, secondary payers will pay the claim off entirely, but due to some account discrepancies between the Primary Payer and the Secondary Payer, a small balance will remain in our application for this claim. Sometimes this balance just needs written off.  Other times, the claim may actually need to go to the patient via a statement.  This error gives you the ability to make that decision.

  • Ignore the error
  • Write off the balance

You can find the 'Patient Responsibility Amount' by opening the EOB linked to the deposit.

About this Error: If the Patient Responsibility on an ERA comes in as $0, the system will now display an error after the posting process if the patient responsibility on the claim in our application is not $0. 

This will prevent balances from being sent to patients on statements when they should not be responsible. 

Pro Tip:  In addition, practices can also use the "Patient Responsibility Claim Status ID" Company Setting to set claims that get this error to a specific status.  By moving it to a different status, it will ensure the claim does not get added to a statement batch before the posting team has had a chance to resolve that error.