|
But
beware the payers who seem to be unable to accept more than one claim within a
single SBR. If you repeat the CLM loop 2300 within a 2000B, you'll
get back rejections like the sum of the claim lines not equal to the total
charges reported in the CLM segment.
Actually neither option is correct. You cannot mix a subscriber's
with a patient's claims, unless you repeat the subscriber
loop.
Given this premise, then if you modify option one by copying line one
between lines three and four you would have a valid transaction set. The
end result would be as follows:
OPTION1
1.
Subcriber1(2000B,2010BA,2010BB)
2.
Clm(2300)
3.
Service(2400)
3.5.Subcriber1(2000B,2010BA,2010BB)
4. Patient 1(2000C,2010CA)
5.
Claim
6. Service
7. Service
8. Patient
2
9.
Claim
10. Service
11. Claim
12. Service
13. Service
14.Subscriber2.......
Tom Drinkard
EDIT,
Inc.
(678) 795-1251 (voice)
(775) 458-6117 (fax)
For 837P, I have a question regarding mutiple
claims for one patient. For example in a transaction, Subscriber1 has two
dependents. Subscriber1 has one claim, one claim for dependent
Patient1, two claims for dependent Patient2.
Which is a right approach - option1 or
option2(Notice the difference at line 11). Or, am I thinking in a wrong
track, as mutiple claim lines for one patient under same Provider in same
transaction set will not occur(only mutiple service lines). Thanks in
advance.
OPTION1
1. Subcriber1(2000B,2010BA,2010BB)
2.
Clm(2300)
3.
Service(2400)
4. Patient
1(2000C,2010CA)
5.
Claim
6.
Service
7.
Service
8. Patient 2
9.
Claim
10.
Service
11. Claim
12.
Service
13.
Service
14.Subscriber2.......
OPTION2
1. Subcriber1
2.
Clm
3.
Service
4. Patient 1
5.
Claim
6.
Service
7.
Service
8. Patient 2
9.
Claim
10.
Service
11. Patient 2
12. Claim
13.
Service
14.
Service
15.Subscriber2.......
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