Re: About Bundling & Unbundling

[Jan Root]

Durga, Yes, although payers are required to use national code sets, payers are allowed to continue their current adjudication processes.  Hence, payers may bundle or unbundle service lines to meet their business/contractual needs. Bundling and unbundling only impact COB claims; i.e., those claims which contain payment information (information that came in on the 835).  The job of the entity creating the COB claim is to correctly crosswalk the payment information (including any bundling/unbundling) from the 835 to the 837.  Does that answer your question? Jan Root [EMAIL PROTECTED] wrote:   Hi, I would like to know clarification on the issue - the bundling & unbundling of services & procedures in Claims The transaction guide for Healthcare Claim - Professional defines this process as follows :- " Procedure code bundling or unbundling occurs when a payer believes that the actualservices performed and reported for payment in a claim can be represented by a different group of procedure codes. Bundling occurs when two or more reported procedure codes are paid under only one procedure code. Unbundling occurs when one submitted procedure code is paid and reported back as two or more procedure codes. In the interest of standardization, payers should perform bundling or unbundling in a consistent manner when including their explanation of benefits on a claim. " Now, HIPAA mandates standards to all Procedural Codes and Service Units in the form of Code sets. Hence, both the providers & payers are to follow the same procedural standards, whether at a higher level or at a unit level. In this scenario, I would like to know whether this concept of Bundling and Unbundling has any significance in generating the Claims. Any more thoughts on this would be appreciated     Thanks Durga     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. ********************************************************************** 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.