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Back  RFI # 1704: Split Line for Partial Pmt 835

Formal vs. Informal Help Informal Formal

Submitter

Dianne Hagen

Description

How would the 835 look in the following Work Comp split line scenario:
Claim with two services totaling $6,000.00
Service 1 is for $3,800.00 with 1 UOS
Benefit payment is $2,500.00
Work Comp CAS reduction is $1,000.00
Provider liability is $300.00
Service 2 is for $2,200.00 with 1 UOS
Benefit payment is $2,000.00
Provider liability is $200.00
Total Commercial benefit payment is $4,500.00
Provider write-off is $500.00
Work Comp payment is $1,000.00 (PR19)

What should be the charge amount in CLP03 for Service 1 and the split line for Service 3? If you only have one unit of service and you split the line how do you reflect the UOS?

Submitter Assigned Keywords

Split Line for Partial Payment 835

Response

The scenario of secondary health payer to workers’ comp payment on a given service is not representative of real world claim processing. There is no Coordination of benefits (COB) on a single service line between workers’ comp and a health plan.
The question regarding the SVC3 amount does not apply since this is not a valid reason for splitting a service line and the question about the units also does not apply since the line is not to be split. See Section 1.10.2.14.1 - Service Line Splitting, for additional information.
If there is a specific question related to Property and Casualty and COB, please submit a new RFI.
Submission 11/8/2012
Status Date 2/5/2013
Status F - Final
Primary References
Document 005010X221
Section1.10.2.1