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. ********************************************************************** 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.
