Based on the knowledge that Hipaa is not meant to change the way a
organization conducts its business I would like to get any feedback on the
following:
If a Hospital has within its contract with the payer that they will send
covered services on a bill and non-covered services on a separate bill and
instead they send all services on a single bill, is it still acceptable for
the payer to deny the claim containing both covered an non-covered services
and request the provider to split the claim and resubmit two. Technically we
did accept the claim into our adjudication system but now are denying based
on a business rule.
Thanks
Mike Winston
Trigon ISD
Ext 44521
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