Claim Repriced but Allowed Amount = Billed Amount?
If there is a claim that comes through as repriced but the allowed amount is the same as the billed amount, there are a few reasons this could happen:
- The provider billed their contracted rate
- The member was outside of their effective dates and do not qualify for the network repriced amount (there will be an EOB or 'log a call' note, typically)
- Their plan has no network (the vision plan, Basic plan, or some Zion plans)