How to Pay a Claim that has been Bundled?

[Jim Moores]

Hi All,     Question....  We bundle claim lines for a number of reasons, and we pay them as bundled today.  In the future, of course, we will have to create an 835 with all the original lines as we received them.     I need some feedback from all the members but I'm particularly interested in the provider community....     If we get a 4 line claim and we collapse the lines into 1 line (ie a Physical Therapy Claim with 4 modes in one visit... for example).  We'll collapse that into a internal CPT4 code to price it as one visit with moderate levels of treatment.  When we pay we must translate that one line (with it's internal code) back into the four lines on the 835.  What we're proposing to do is pro-rate the payment amount across all non-rejected lines that were bundled based upon submitted charge (in this case all four lines would get a portion of the payment).     Question:  Would this be HIPAA compliant and would the provider systems be able to process the 835?     Everything that I've been able to find on this situation suggests that as long as we return what we received on the 837 and follow the rules in constructing the 835 regarding payment specific data elements, we should be compliant.     Any thoughts or comments are welcome....   Jim Moores   Jim Moores - HIPAA Team Leader - Privacy Antares Management Solutions 23700 Commerce Park Road Beachwood, Ohio   44122-5832   [EMAIL PROTECTED] Phone: (216)292-1605 Fax:      (216)292-1619   ********************************************************************** 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. ===================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited. ------------------------------------------------------------------------------ CONFIDENTIALITY NOTICE: This message is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential or exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that you are strictly prohibited from printing, storing, disseminating, distributing or copying this communication. If you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. Thank You, Antares Management Solutions. ==============================================================================