A TRICK QUESTION.. If an incoming COB Claim does not have all the original lines, how would the secondary payer be able to detect that this claim is not compliant?
(or A tree falls in the forest with no one around, does it still make a noise?) :-))) Julie From: [EMAIL PROTECTED] To: [EMAIL PROTECTED], [EMAIL PROTECTED] Subject: Re: COB / 835 Question Date: Thu, 11 Oct 2001 20:59:48 EDT Paul: If 2 health plans mutually engage in COB, the receiver of the original claim should not be sending charges THEY bundled to the next payer. The first payer should be sending the originally submitted charges to the second payer. You shouldn't have to figure out how to reconcile to original charges... The preamble of the Final Rule says "With respect to COB, if a health plan electronically performs COB exchange with another health plan or other payer, then it must store the COB data necessary to forward the transaction to that health plan or other payer." Also, in the regulation, section 162.925 (b) it says " Coordination of Benefits. If a health plan receives a standard transaction and coordinates benefits with another health plan (or another payer) it must store the coordination of benefits data it needs to forward the standard transaction to the other health plan (or other payer). Maria Ward << If a payer receives COB claims that contain bundled charges, not the originally submitted charges, how does the health plan reconcile the submitted charges to the paid amounts on an 835 - if the original charges were not passed? Thanks, Paul >> ********************************************************************** 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. _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp ********************************************************************** 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.
