During our mapping of the 837 we have encountered an issue with the fact that one
claim can have different rendering providers at the claim detail level. As an access
only PPO our main function is to perform claim re-pricing and then forward these
repriced claims to the appropriate payers for payment.
Our claims transaction system only allows one provider contract per claim for
repricing, so are we allowed to split the claim when the rendering provider changes
and send out multiple claims to our payers when different rendering providers are
received in the detail segment (Loop 2420A)?
Any guidance is much appreciated?
Juliet Mees
Director, Technology Compliance
Sloans Lake Managed Care
303-504-5350
[EMAIL PROTECTED]
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