Problem Statement

Credit balances must be reviewed and resolved through refund or adjustment within payer and regulatory timeframes, and working them manually is slow; unresolved credits inflate Net Days in Credit Balance and create compliance exposure. Not every credit should be refunded: payers set an overpayment-identification timeframe, and once a credit is past it, the right resolution is to adjust it off rather than issue a refund. Telling which credits have crossed that threshold means checking each one's age against the payer's timeframe, repetitive work where misclassifying a credit either triggers an unnecessary refund or leaves a credit sitting that should have been cleared.

Automation Solution

This automation identifies insurance overpayments that exceed the payer's overpayment-identification timeframe so the credit can be adjusted off rather than refunded.