How to handle Adjustments....?

[Jim Moores]

Hi All,     A quick question.... we think that we have a plan on how to handle 837 Adjustments within the limitations of our systems (for now).  The question is... Is it an acceptable solution for HIPAA.     We propose to accept all 837 Adjustments, then do two things:  Dump the 837 Adjustment data to paper for internal use and reject the electronic version back with an 835.  We will then send the paper version of the adjustment to our "Adjustments Research" unit, where the adjustment will be researched and, if warranted, acted upon by adjusting the original claim record in our claims system.  This will result in a "debit" and a "credit" 835 to be generated.     The question is - Are we compliant if what the provider sees from us (the payer) is:   1)  All 837 Adjustments that they send to us are rejected on an 835. 2)  For all the adjustments that we accept and act upon, they will receive 2 835's... (1) a credit of the original claim and (2) a debit with the changes/adjustments that we accepted (using all the data as sent to use originally in combination with the changes that we accepted from the Adjustment 837... not as sent on the adjustments 835 that we rejected).     That would be a total of 3 835s for every one adjustment that we accept and 1 835 that we don't accept the adjustment.     I can't see anywhere in the regs or IG's that say you have act on an 837 other than (by implication) return an 835.  And there is nothing that I can see where we wouldn't be allowed to send multiple 835's for one 837....     So where is my logic faulty?  Any feedback is 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. ==============================================================================