How to Enter a Recoupment from a Payor.

Sometimes you will receive an EOMB (Explanation of Medical Benefits) which contains notification that the payor recouped a payment which it had previously made. There are generally two reasons this may happen.

If the payor had previously paid the claim and then paid it again a second time, the claim will show a credit balance of the payment amount. When this happens, you will need to reverse the payment which will leave the claim with a Remaining Balance of zero.

If the payor had previously paid the claim, but now believes it should not have, it may recoup the previous payment. When this happens, you will need to reapply the recouped amount to the claim to show it open instead of paid.

The process of entering a recoupment is the same as Reversing a Payment.