Unresolved Medicare Cap Charges

The Unresolved Medicare Cap Charges report displays all open charges for patients with Medicare as their primary or secondary insurance. Important: Any charges where the KX modifier has been applied will not be included in this report. Additionally, any charges without a balance will not be included.

For Self-Service Members: If you haven't completed the Medicare Allowable Amount field in all your Procedure Codes, this report will not be accurate. 

Review Your Charges

1. Begin by selecting Denial Management, then Unresolved Medicare Cap Charges. 
2. Complete the Search Criteria then click Search. For the Payment field, enter the dollar amount for the patient that has already charged to Medicare. So for the example below, the patient must have had $25 or more estimated allowable amount charged to Medicare that has not been paid. 
3. The results will show each of the patients that fall within the search criteria. Click the Detail link for a patient. 
4. This page will show the detailed charge information including procedure codes, units, and modifiers for each of the patient’s Dates of Service. 
5. Print or Export each of these pages as needed.