We billed a claim with several CPTs, and the allowable for the primary code was higher than the entire amount of the claim. When this happens, we expect the claim to allow at 100% of ‘billed’ charges. However, the payor paid less than the billed charges. I inquired about this, and their response was it hit lesser of billed provision.
Does anyone know what this means in simple terms? Their response was a little over my head.
Thank you!