I believe that both of you are correct. The original service lines should be sent in Loop 2400 of the 837I and the adjudicated lines should be sent in Loop 2430. This will give you both the claim as it originally appeared as well as how each payer has adjudicated it.
Comments please. Thanks! Jonathan Showalter Omaha NE USA 402-343-3381 [EMAIL PROTECTED] ------------------( Forwarded letter 1 follows )--------------------- Date: Thu, 11 Oct 2001 20:59:48 EDT To: [EMAIL PROTECTED], [EMAIL PROTECTED] From: [EMAIL PROTECTED] Sender: [EMAIL PROTECTED] Subject: Re: COB / 835 Question 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. ********************************************************************** 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.
