CollaborateMD: How to Submit a Corrected Claim When the Error "Payments and Adjustments Must Be Deleted or Refunded" Appears

Issue

When submitting a corrected claim, the following error may appear:

"The payments and/or adjustments on this charge must be deleted or refunded/reversed before the amount can be reduced."

Environment

CollaborateMD, Roles: Admin, Features: Claim, Claims

Resolution

This error occurs when a claim was submitted and paid, leaving the charge balance at $0.00. While submitting a charge with a $0.00 amount is generally allowed, issues arise when correcting a previously submitted charge that had a higher billed amount and now includes payments and/or adjustments. The system prevents charge balances from becoming negative.

Example

If a $100.00 charge has $50.00 in total payments and adjustments, the charge cannot be reduced below $50.00, because doing so would result in a negative balance.

To reduce the charge to $0.00 (or below the original amount), you have two options:

Option 1: Update the EOB Action to Denied

• Change the Explanation of Benefits (EOB) action from Processed to Denied.
• This option applies only when the payment amount was $0.00 and the payer issued an adjustment.
• When updated to Denied, adjustment amounts move from the Adjusted column to the Unpaid column, which does not affect the total charge balance.

Note: This is the most common scenario. You may need to configure correct remittance actions so the system automatically marks certain codes as Denied, even when the payer does not explicitly label them as such. For assistance, contact Integrated Billing Support at [e-mail].

Option 2: Adjust or Remove Payments and Adjustments

• Delete or set prior payment and adjustment amounts to $0.00.
• Reducing these entries increases the charge balance, allowing the charge amount to be lowered as needed.

Cause

This issue occurs when attempting to re-submit a corrected claim for a charge that was previously billed, paid, and reduced to a $0.00 balance.