The issue, for me, is not reporting the
adjustments, it’s reporting the payments at the line level as we don’t track
that information today. The adjustments have always been tracked.
____________________
Jennifer Lynne
Jones
Sanitas Product Manager
Pinpoint Technologies
Boulder,
CO 80301
303-801-1829 (Direct)
303-801-0001
(Fax)
-----Original
Message-----
From: Mike Urban
[mailto:[EMAIL PROTECTED]
Sent: Monday, September 22, 2003
8:23 AM
To: WEDI SNIP Transactions
Workgroup List
Subject: RE: COB Balancing
No.
This note in the SVC is pretty clear:
Although the SVC loop is optional, there are times when it should
be considered mandatory. Whenever the actual payment has been reduced due to
service line specific adjustments, the SVC loop is necessary in order to
understand the remittance information. This situation is particularly
applicable to professional and fee-based services.
Even if
you consider "should be considered mandatory" to by synonymous with
"required" (they are not), the SVC segment is only needed when
adjustments reduce the amount paid.
-----Original
Message-----
From: Dave Foulke
[mailto:[EMAIL PROTECTED]
Sent: Monday, September 22, 2003
8:54 AM
To: WEDI SNIP Transactions
Workgroup List
Subject: RE: COB Balancing
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
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
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----- Original Message -----
To: WEDI SNIP Transactions Workgroup List
Cc: WEDI SNIP Transactions Workgroup List
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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