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Robert,
Also, how can the Clearinghouse possibly know what the EOB or
835 you received contained?
As you pointed out, the 837 must accurately report what was
received from the primary payer.
Requiring service-line level adjustments when you do not have
service-line level information is just plain wrong.
The opinions expressed here are my own and not
necessarily the opinion of LCMH.
Douglas M. Webb
Computer System
Engineer
Little Company of Mary Hospital & Health Care Centers
[EMAIL PROTECTED]
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----- Original Message -----
Sent: Monday, September 22, 2003 07:16
AM
Subject: Re: COB Balancing
Jenn, what is reported on the remittance advice is what
must be reflected
on the 837 secondary/tertiary claim(s). The 835
Implementation Guide on
page 20 near the bottom in the description for
Amount 8 the note indicates
the amount can be transmitted in the Claim
Adjustment Segment and/or the
Service Adjustment Segment.
Additionally, the third paragraph on page 21
states "When the Service
Payment Information loop is present, adjustments
are reported in either
(emphasis added) the Claim Adjustment or the Service
Adjustment Segments
but not in both. The example provided basically points
out that the
same adjustment should not be repeated at both the claim and
service
level. Also the IG notes the preference that the adjustment be
shown
at the service level when possible.
I do not see how a clearinghouse
can demand that adjustments be shown at
the service level if the prior
payer reported the adjustments at the claim
level. At the same time
you might as well be prepared to report service
level adjustments when a
payer adjudicates and returns service level
adjustments.
Robert C.
Pozniak
NYS Department of Health
HIPAA Practice
Group
"Jones,
Jennifer"
<[EMAIL PROTECTED]
To: "WEDI SNIP Transactions Workgroup
List"
ech.com>
<[EMAIL PROTECTED]>
cc:
09/19/2003 03:55
Subject: COB
Balancing
PM
Please respond
to
"Jones,
Jennifer"
I'm sure it is late in the game to asking about
this but I haven't had this
request until recently ?
I have
aClearinghouse who is requesting COB information at both the claim
and line
level.I have not been doing this for other payers so now I'm
forced to
change it (for one situation).
I'm frustrated because I've gotten this
far in the game and been able to
successfully send COB claims with this
information at only the claim level.
Iguess, before I do it, I want to
make sure I should ?
Thanks ---
jenn
____________________
Jennifer Lynne Jones
Sanitas
Product Manager>
Pinpoint Technologies
Boulder, CO
80301
303-801-1829 (Direct)
303-801-0001 (Fax)
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