Stanley,
Below is an 837 transaction we recieved in a test file from our Clearinghouse that does our Medicare Crossover claims. Medicare has made their payment, and the claim is being sent to us as the supplemental payer. It appears to us that the Clearinghouse is incorrectly mapping the Payer, and the Other Payer loops.
It is our understanding that the Payer segment should be the "destination payer", in this case, that is now us (State Farm). Medicare, should be the Other Payer at this point. Are we correct in our assumption? I have changed the NM1 and SBR segments the way I think they should be. Do you agree?
Thanks for you help!!
HL*7**20*1~
NM1*85*2*BAPTIST HEALTH CARE*****24*590657322~
N3*1000 W. MORENO STREET~
N4*PENSACOLA*FL*325010000~
HL*8*7*22*0~
SBR*P*18**R19360410M*****MA~ SBR*S*18**Med Supp*****CI~
NM1*IL*1*CRUTCHFIELD*TOMMY*R***MI*466484181A~
N3*1301 CUSTER RD*APT 202-222~
N4*PLANO*TX*750757491~
DMG*D8*19360410*M~
NM1*PR*2*MEDICARE*****PI*00090~ NM1*PR*2*State Farm Ins*****PI*123456789~
CLM*004809091347B*1427***14:A:1*Y*A*Y*Y*********N~
DTP*096*TM*9900~
DTP*434*RD8*20011215-20011215~
DTP*435*DT*000000009900~
CL1*0*1*01~
REF*EA*000480909~
HI*BK:71946~
HI*BF:71596*BF:8360*BF:8442*BF:73309*BF:7823~
HI*BH:18:D8:20000401*BH:A2:D8:20000401*BH:B2:D8:20011203*BH:A1:D8:20360410*BH:B1
HI*BE:A2:::214.9*BE:76:::23~
HI*BG:09*BG:C5~
NM1*71*1*SAITER*JOSEPH****XX*D53184~
SBR*S*18**MED SUPP*****11~ SBR*P*18**R19360410M*****MA~
CAS*CO*A2*1049.99~
CAS*PR*2*214.9~
AMT*B6*1427~
AMT*T3*1427~
AMT*N1*162.11~
AMT*PG*1427~
AMT*B1*1427~
DMG*D8*19360410*M~
OI***Y***Y~
MIA*1***37701~
MOA*0.23~
NM1*IL*1*CRUTCHFIELD*TOMMY*R***MI*HC2597224343~
N3*1301 CUSTER RD*APT 202-222~
N4*PLANO*TX*750757491~
NM1*PR*2*STATE FARM INSURANCE*****PI*NONE~ NM1*PR*1*MEDICARE*****PI*00090~
LX*1~
SV2*0610*HC:73721:LT*1427*UN*1~
DTP*472*D8*20011215~
SVD*00090*0**0610*1~
CAS*PR*2*214.9~
SVD*00090*0**0610*1~
CAS*CO*45*1049.99~
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