Correct me if I'm incorrect, but 835's
returning payment information on professional claims are required to return
service line information are they not? Therefore there has to be SOME service
line information, even it's nothing more than one payment.
Thanks
Dave
David G. Foulke
Software Development
Dairyland Healthcare Solutions
320-634-5331
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-----Original Message-----
From: Doug Webb
[mailto:[EMAIL PROTECTED]
Sent: Monday, September 22, 2003
8:16 AM
To: WEDI SNIP Transactions
Workgroup List
Cc: WEDI SNIP Transactions
Workgroup List
Subject: Re: COB Balancing
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
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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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