----- Original Message ----- From: Rachel Foerster <[EMAIL PROTECTED]> To: 'WEDi/SNIP ID & Routing' <[EMAIL PROTECTED]> Sent: Friday, July 12, 2002 11:56 AM Subject: RE: CPP and COB
> Ken, > > If I'm not mistaken, the payer-to-payer model is currently what Medicare > follows where Medicare processes/adjudicates as primary and then forwards > the claim on to the Medigap insurer....right? Right. I know this because I developed the application which produced the '837 COB' transaction for a large Medicare Part A FI. >Is the secondary payer (Medigap in this example) be identified in the primary claim submission or > through some other mechanism today... In the case cited above, the secondary payer was identified OUTSIDE the data provided on the original claim; a (very) (large) file called "The Eligibility File" is checked using the patient's HIC #. This file contains the secondary payer info for the patient/insured. (For Medicare, patient always = insured, unless Congress got into the act recently.). Michael Mattias Tal Systems, Inc. Racine WI [EMAIL PROTECTED] discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
