How are health plans accommodating the required 837 Professional elements
that can not be obtained from a paper claim?
ambulance services, spinal manipulation, pregnancy
For example,
If a chiropractor does a spinal manipulation, we would expect him to submit
his bill on a HCFA 1500 claim form
For spinal manipulation, there are several required fields within the 837.
Within the 2300 loop CR2 detail (Spinal Manipulation Service Information),
the following information is required and can not be found on a paper
claim:
Treatment Series Number, Treatment Count, Subluxation Level Code,
Treatment Period Count
Monthly Treatment Count, Patient Condition Code, Complication
Indicator
For ambulance transports, loop 2300 detail CR1 (Ambulance Certification),
required and not on a paper claim
Ambulance Transport Code, Ambulance Transport Reason Code.
For obstetrical claims, the paper claim provides the last menstrual cycle
date but not the estimated date of birth.
We are required to include this information when we submit the 837 to our
state agency.
Has anyone addressed and or resolved an issue similar to this?
NOTE: This is a re-send of two earlier emails that have experienced receipt
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