I am trying to figure out the intended use of the wording in the 835 IG
front matter where it says the following:
"The 835 is used to provide financial notification of capitation
payments from a
Managed Care Organization (MCO) to a capitated care provider. The
835 does
not contain the capitation details or membership roster. Use an
associated Eligibility
and Benefits Notification Transaction Set (271) to communicate these
details.
Capitation payments may be included with claims payment information
in a single
835 or they may be passed alone. In either case, the existing
balancing process
for the 835 applies."
Is this implying that a 270 has to be sent for every occurrence at the
member level since there is no 271 unsolicited? Has anyone considered using
this process? If so, how?
Thanks,
Deborah Sparma
Datateck Consulting Group
[EMAIL PROTECTED]
(303) 534-0109
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