Mike, I don't remember seeing an answer to this question.
As far as I know, the payer can set whatever business rules they want, as long as electronic submitters are not penalized by having to comply with different rules than paper submitters. Kepa "Winston, Mike K." wrote: > > 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 > [EMAIL PROTECTED] > > This message, including files attached to it, may contain confidential > information that is intended only for the use of the ADDRESSEE(S) named > above. If you are not the intended recipient, you are hereby notified that > any dissemination or copying of the information is strictly prohibited. If > you have received this message in error, please notify the sender > immediately and delete the message from your system. Thank you. > > ********************************************************************** > To be removed from this list, send a message to: [EMAIL PROTECTED] > Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request.
