Unassigned Claim (Health Care) Law and Legal Definition
Unassigned claim means claim submitted for a service or supply provided by a physician or a supplier who does not accept assignment. Generally when a physician or supplier accepts medicare’s approved charge as full payment, then s/he is said to have accepted the assignment and the claim that they make is called an assigned claim. If a physician or supplier does not agree to accept medicare’s approved charge as the total charge, then his/her claim is called an unassigned claim. Physicians and suppliers who submit unassigned claims will not accept medicare’s approved amount as payment in full.
Generally, medicare pays 80 percent of the approved charge and the rest of the 20 percent amount is paid by the beneficiary. For consulting a doctor who does not accept assignment, beneficiaries need to pay the full amount. A doctor who does not accept assignment may charge up to 115% which means a beneficiary is responsible for the 20 percent coinsurance amounts and, for unassigned claims which is the difference between the medicare allowed amount and the supplier's charge.