Mike
First, I think what you're talking about is termed 'unbundling'. Bundling is the
term used when for example (in the past) the provider submitted three service
lines and the payer bundled them up into one or two service lines. While payers
may still 'bundle' in the sense that they can roll up lines, the 835 requires
that they return the same number of lines that were submitted, at least as a
minimum. Please see pages 25-27 of the 835 for an excellent discussion of
bundling, unbundling and partial unbundling.
Unbundling is when the payer wants to create more lines that were billed which it
sounds like what you want to do. As far as the units go I think this is what
you'd show in the 835:
Billed Paid CAS unit adjustment **
81002 3 2 1
81005 3 2 1
81015 3 2 1
81000 0 1 -1
So, in this case, you would add a line to the 835 (the 81000) and adjust the
units accordingly so that billed = paid.
**To quote from the imp guide: "A positive value decreases the paid units of
service, and a negative number increases the paid units." The units adjustment
goes in CAS04, 07, etc.
"Winston, Mike K." wrote:
> Can anyone give an example of how you would show on the 835 that some units
> from submitted lines were used to create a new line?
> Example:3 lines billed, procedures 81002,81005 and 81015 each was billed
> with 3 units for the same date of service we currently would take 1 unit
> from each line and create a line with procedure 81000. The 835 will have 4
> lines going out 81002,81005,81015 each with 2 units and 81000 with 1 unit.
> Would it be ok to send out a forth line when only three was submitted if we
> could not show the forth line as resulting from bundling?
>
> Thanks
>
> Mike Winston
> Trigon ISD
> Ext 44521
> [EMAIL PROTECTED]
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