We currently receive claims for secondary payment, where Medicare made the primary payment. We are trying to determine the appropriate way to create the 835 CAS segment for the following situation:
The provider charged $100.00 for the service and Medicare paid that service in full. We then receive that claim from the Medicare Intermediary on an 837COB transaction. For some reason (timely filing, for example) we do not even consider paying that service and reject the claim line. Would it be more appropriate to create the CAS segment with an adjustment group code of PI (payer initiated) and an adjustment reason of 23 (paid by another carrier), or would it be appropriate to create the CAS segment with an adjustment group code of PI and an adjustment reason of 29 (time limit for filing has expired). Basically, is it more important to a provider to know the payment by the other insurer (Medicare), or would they want to know the appropriate reject reason for which we denied the claim. If anyone has discussed this situation, or has an opinion on this, please let me know. Thanks in advance, Bill Sayman
