RE: 835 and DRG Processing

[Jim Whicker]

I would assume that anyone who sets up a DRG payment contract between a payer and a provier would agree to the grouper that is to be used.  As such - there should be few exceptions between billed/paid DRG.  Medicare on occasion will change the DRG in their payment - and that's part of our monitoring of our payments from Medicare A - is to monitor the Paid vs Billed DRG issues.  If we have an issue with how they pay - that's part of the post payment followup process - and also one reason from a provider point of view I don't want Payer to Payer COB! >>> [EMAIL PROTECTED] 07/15/02 10:32AM >>> Excellent question as we have that same concern.  We double check all DRG's submitted which sometimes results in our changing them to process the claim. Claudia Melendrez Service Manager 923-6736 3-222-6736 -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Monday, July 15, 2002 8:38 AM To: [EMAIL PROTECTED] Subject: TCS: 835 and DRG Processing If we received a DRG code in on an 837 but our DRG processing software reviewed the procedure and diagnosis codes and returned a different DRG through our adjudication system, would we be noncompliant if we sent that DRG code back out on the 835? Kelly R.Davis Nationwide Health Plans HIPAA Project Coordinator [EMAIL PROTECTED] ********************************************************************** 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. ********************************************************************** 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. --- PRESBYTERIAN HEALTHCARE SERVICES DISCLAIMER --- This message originates from Presbyterian Healthcare Services or one of its affiliated organizations. It contains information, which may be confidential or privileged, and is intended only for the individual or entity named above. It is prohibited for anyone else to disclose, copy, distribute or use the contents of this message. All personal messages express views solely of the sender, which are not to be attributed to Presbyterian Healthcare Services or any of its affiliated organizations, and may not be distributed without this disclaimer. If you received this message in error, please notify us immediately at [EMAIL PROTECTED] ********************************************************************** 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.