I represent a clearinghouse that is encountering some difficulty in
implementation of the ANSI 837 4010 with some Medicare contractors and am
looking to see if anyone else has experienced this issue and can offer their
advice. We have come across an impasse with interpretation of the 837 IG in
relation to submission of a Medicare Primary claim with a supplemental
payer. Note 1 of the 2330B NM109 in the IG states the following:

1. Submitters are required to send all known information on other payers in
this Loop ID-2330.

If this segment is used, the NM109 (Payer Identifier) is a required element.
We have identified that the Medigap number for the Medigap payer to a
Medicare Primary claim will populate this element. The problem we are
encountering is related to non-Medigap payers on a Medicare Primary claim.
We are being advised by a couple contractors to not report the other
insurance on the claim even though it is known for complimentary cross over
situations. It has been stated that if it is a payer in which the Medicare
contractor has a complimentary crossover contract, they do not want to see
the other payer reported on the claim at all. This seems to be in direct
contradiction to the above statement in the IG. 

When we queried further to determine if the other payer was to be reported
on the claim, as per the IG requirement, what value would be
allowed/required in the NM109. The response was that no default value would
be allowed and essentially would cause the claim to reject if a value was
sent that was not valid. It has also been stated by another contractor to
leave this element blank.  This poses a problem since a blank value does not
meet ANSI syntax requirements.

Has anyone else encountered this issue in testing and how is it being
handled? Are you
just not reporting/suppressing the other payer on the claim even though it
is known? Can the claim be rejected if the data is being sent by another
covered entity per IG requirements? Can CMS provide clarification on this
point?

Thank you.



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