“Office UCR Fees” is selected if the office determines the UCR fees are charged to the insurance carrier regardless of any manual fee adjustments. Office UCR fees are generally higher than any allowed by insurance carriers.
For the instance of a managed care or Medicaid plan, the plan should be attached to a fee schedule and the field is indicated as “Actual Charges”, the schedule’s fees are submitted to the insurance carrier. Regardless of the actual allowable insurance payment, only the amount submitted will be collectable from the carrier.
If an insurance carrier has increased payment for a submitted procedure and an office has “Actual Charges” indicated, the higher payment will not be paid by the carrier. Therefore, to obtain possibly higher insurance payments, it is advised to select “Office UCR Fees” for plans.