Thank you to everyone for your assistance in this matter. I appreciate your input!
____________________ Jennifer Lynne Jones Sanitas Product Manager Pinpoint Technologies Boulder, CO 80301 303-801-1829 (Direct) 303-801-0001 (Fax) -----Original Message----- From: Robert C. Pozniak [mailto:[EMAIL PROTECTED] Sent: Monday, September 22, 2003 6:17 AM To: Jones, Jennifer Cc: WEDI SNIP Transactions Workgroup List 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) --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
