Re: How to Pay a Claim that has been Bundled?

[Jim Moores]

Hi Doug,     Thank you for the prompt reply.   We'll have to blame my lack of clarity in describing the situation... when I said "We'll collapse that into a internal CPT4 code ", I meant that we would collapse into an internal local "W" code for pricing.     So, to summarize Bob's (and your) answer, given my clarification, we could spread the payment information across all of the non-rejected lines when we "bundle" into an internal local code, but would have to follow  "the bundling instructions in section 2.2.6" if we bundle into a VALID CPT code.   Again, thank you for your prompt and informative answer,   Jim   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     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   >>> <[EMAIL PROTECTED]> 04/09/02 03:06PM >>> Jim, See attached response from Bob Poiesz, who is one of the co-chairs of the 835 workgroup in X12.  Bob's reference to section 2.2.6 is in the 835 4010 implementation guide.  Hope this helps. Doug Renshaw Highmark ______________________(Snip)______________________________________________ Doug, Based upon the wording of the question, there are two possible situations. 1 - If the bundled "internal CPT4 code" is a local code internal to their system only, then they are using valid logic. They can not send out that local code in the 835 and be compliant. 2 - If the bundled code is a valid (HIPAA compliant) CPT4 code then they should be following the bundling instructions in section 2.2.6.  The procedure described below is not consistent with those instructions.  While all of the original lines need to be returned on the 835, only one of the bundled lines would show a payment. Bob ______________________(Snip)______________________________________________ ********************************************************************** 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. ==============================================================================