Who is Pay to provider and what is offset


Pay-to-provider is a term used in the Medicaid program to refer to the enrolled
Medicaid provider who receives payment from Medicaid for covered services
provided to eligible recipients. The pay-to-provider can be the provider who
has provided treatment to a Medicaid recipient or the provider group to which
the treating provider belongs.

What is Offset

When an Insurance company had paid excess amount in the previous EOB to the provider or the billing office it will adjust that excess amount in the next EOB they sent (by reducing the exceeded amount). Thus the process of adjusting the excess amount paid by the insurance to the provider in their next EOB is called “OFFSET”.

What Is Difference Between Claim Rejection And Claim Denial?

Claim may have been rejected for lack of information that you didn’t provide ,denial usually means what ever you have applied for you didn’t get and that could lead back to the rejection due to lack of information.


There is no relationships between above three question so dont cofuse.

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