Bob, I am not sure what you mean by cross-footing, but, - The lines must balance with the line item adjustments in the CAS. - The claim must balance with all its line items and the claim level adjustments. - The transaction must balance with all the claims and the PLB adjustments.
So, if there are prior payments, because a claim is paid in two 835s, the second 835 must reflect as an adjustment any and all prior payments. You cannot just create two partial 835s and somehow expect them to be merged by the provider. There is one, first, 835 and another, second, 835, and potentially more. As the list of 835s grows, the subsequent 835s must reflect the "previously paid" amounts in their CAS segments. Otherwise the service line loop in question will not be in balance. This is, I think, clearly described in the 835 IG. I hope this helps. Kepa On Wednesday 09 October 2002 08:23 pm, Bob Ford wrote: > No one has responded to this posting. Can anyone advise when I can seek > counsel on this matter? > > > Bob Ford > [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]> > 401-822-1962 > > > -----Original Message----- > From: Bob Ford > Sent: Monday, October 07, 2002 8:12 AM > To: '[EMAIL PROTECTED]' > Subject: 835 Balancing and cross footing > > I am currently working with a vendor on balancing the 835 as > defined in the IG page 19-21. > > It appears we have a difference in opinion as to what is > balancing. They state that > lines balance and the claim balances, but they do not have > to balance or cross foot to > each other. > > Note the example below: > > Simple example ... > 3160 *CLP*018918525*1*97*53**15*13221979281508@ > 3161 CAS*OA*A1*22.08@ > 3162 NM1*QC*1*DROF*TREBOR****MI*525172765@ > 3163 NM1*IL*1*DROF*T*G***MI*525172765@ > 3164 DTM*232*20020607@ > 3165 DTM*233*20020607@ > 3166 PER*CX*ISSUING SERVICE CENTER*TE*4015551212@ > 3167 SVC*HC<88141<90*44*22.08@ > 3168 DTM*472*20020607@ > 3169 CAS*CO*45*21.92@ > 3170 SVC*HC<88142<90*53*53@ > 3171 DTM*472*20020607@ > > > Line Level Balancing > Changes Payments Adjustments > Balance > 44 svc02 22.08 svc03 21.92 > CAS03/06/09/12/15/18 00 > 53 svc02 53.00 svc03 00. > CAS03/06/09/12/15/18 00 > > Transaction Balancing: > 97 clp03 53.00 clp04 22.08 cas @ claim > level > 21.92 cas @ line > level 00 > > Cross Footing: > 97 75.08 44.00 > <22.08> > == <> <> > <> > > In the above example, the transaction does not cross foot. > The IG on page 20 > states: > > When specific service detail is presented, the claim > level balancing includes > balancing the total claim charge (CLP03) to the sum of > the related service > charges (SVC02). Service lines that are not finalized > should be adjusted > with a CAS segment using a Claim Adjustment Group code > (CAS01) of 'OA' > (Other Adjustment), a Claim Adjustment Reason code > (CAS02) of 133 (This > service is suspended pending further review) and the > full dollar amount for > the service in CAS03. When finalized, the claim must be > reported using the > instructions found in the Reversal and Correction > section. See 2.2.11, Definition > of a Claim, for variations related to claim splitting > situations. > > It does not address the issue of previous payments and using > the 'OA' with a > Claim Adjustment Reason code (CAS02) of 13 to report > previous payments and > insuring the transaction cross foots the totals. > > I believe the claim should resemble the following: > > 3160 *CLP*018918525*1*97*53**15*13221979281508@ > 3161 NM1*QC*1*DROF*TREBOR****MI*525172765@ > 3162 NM1*IL*1*DROF*T*G***MI*525172765@ > 3163 DTM*232*20020607@ > 3164 DTM*233*20020607@ > 3165 PER*CX*ISSUING SERVICE CENTER*TE*4015551212@ > 3166 SVC*HC<88141<90*44*0@ > 3167 DTM*472*20020607@ > 3168 CAS*OA*B13*22.08@ > 3169 CAS*CO*45*21.92@ > 3170 SVC*HC<88142<90*53*53@ > 3171 DTM*472*20020607@ > > Line Level Balancing > Changes Payments Adjustments > Balance > 44 svc02 00.00 svc03 44 > CAS03/06/09/12/15/18 00 > 53 svc02 53.00 svc03 00. > 00 > > Transaction Balancing: > 97 clp03 53.00 clp04 44 cas @ line > level 00 > > Cross foot: > 97 53.00 44.00 > 00 > == == == > == > > Can anyone give me some feed back as to if a claim needs to > cross foot? > > Bob Ford > [EMAIL PROTECTED] > 401-822-1962 > > > > > ********************************************************************** > 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. 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