I am asking this question on behalf of a coworker: How are others within the industry reporting the following COB scenario within the 835 Transaction?
The scenario involves COB Claims which are adjudicated using a Higher Allowable calculation. In addition to the original billed amount, claims includes reimbursement for out of pocket expense (perhaps related to this claim, perhaps related to a prior claim) which is being paid because 'funds' are now available due to COB Savings. To further complicate matters, part of the payment is being made to the provider, part to the member. Attached is a spreadsheet showing our proposal for how we might show it in the 835. There is also a tab showing the same data on a paper remittance advice. We would appreciate any suggestions. <<ERA_COB Example.xls>> Please let me know if this question has already been addressed. Thank you. Stacy Stacy Cruise John Deere Health 3800 23rd Ave Moline, Illinois 61265 Phone: 309-765-0465 Fax: 309-749-1239 E-mail: [EMAIL PROTECTED]
ERA_COB Example.xls
Description: MS-Excel spreadsheet
