Patient Records

Insurance Claim Amount Incorrect

Problem: The amount submitted on an insurance claim doesn’t match what was billed to the patient.

Possible Causes

Insurance plan’s coverage percentage or copay rules are outdated in the system.
A service was billed under the wrong procedure code.
Claim was generated before a late billing adjustment was applied.
Patient has two active insurance plans and coordination-of-benefits rules weren’t applied.

Verify the patient’s insurance plan details under Patients → Insurance are current.
Cross-check the procedure code against the service actually rendered.
Regenerate the claim after any billing adjustment, don’t edit a submitted claim directly.
For dual coverage, confirm which plan is primary under Coordination of Benefits.

Error Message	Resolution
Claim rejected for coverage mismatch	Confirm the insurance plan and coverage percentage are current, then regenerate.
Copay amount looks wrong	Check the plan’s copay rule under Insurance → Plans.

Tip: Regenerate claims after any late adjustment instead of manually editing a submitted one.

Billing staff with claims-management permission, from Billing → Claims → Resubmit.