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Back  RFI # 214: 837P COB CAS information

Formal vs. Informal Help Informal Formal

Submitter

chip dycio

Description

When to send claim level adjustments (loop 2320) versus line level adjustments (loop 2430) on the 837P transaction for COB (a.k.a. secondary) claims? To illustrate, here are 3 scenarios:
Scenario #1 - Primary payer sent only claim level adjustments
Scenario #2 - Primary payer sent only line level adjustments
Scenario #3 - Primary payer sent both claim level and line level adjustments
Based on these scenarios and my interpretation of the IG, I will create secondary 837P transactions that contain the following:
Scenario #1-send only claim level adjustments (in loop 2320). Do not send line level adjustments.
Scenario #2-send only line level adjustments (in loop 2430). Do not send claim level adjustments.
Scenario #3-send both claim level adjustments (in loop 2320) and line level adjustments (in loop 2430).
Therefore, is the requirement to send either claim level or line level adjustments on a secondary claim determined by whether the prior payer sent claim level or line level adjustments on the 835?

Submitter Assigned Keywords

837P CAS 2320 2430 COB 835 adjustment

Response

The secondary payer utilizes the primary payers adjudication information to determine it's contractual liability as the next payer in line. How the secondary payer reports it's payment is based on the capabilities of it's adjudication application, not on how the primary payer reported it's payment. Generally, if the payer has the capability to report line level adjudication it should do so.
Submission 3/9/2005
Status Date 4/19/2005
Status F - Final
Primary References
Document 004010X098
Section3.1
Page323
Set ID837P
Loop2320
Segment IDCAS