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Back  RFI # 228: 837 - Multiple Primary Payers

Formal vs. Informal Help Informal Formal

Submitter

Paul Wanderscheid

Description

HIR172 says this seems illogical & isnt consistent with the guide. I would like this issue revisited and a more definitive response, one way or another, provided. My org is a beta tester with the CMC COBC project in which all Medicare crossover claims for payers are funneled from CMS through a “clearinghouse”. Claims with multiple primary payers have occurred in our testing and when we reject them CMS interpretation is that there is nothing in the IG that says these are not OK. The situation in which they occur is- the provider submits the claim to Medicare listing another payer as primary probably with Medicare as secondary. However, Medicare determines they actually should be primary and pay as such. Then when they cross the claims to the now secondary payer they maintain the original segment the provider submitted because they say under the guidelines they should not change the original primary segment and must pass it as submitted. Since CMS says this is allowed are they not defining the standard?

Submitter Assigned Keywords

primary payer

Response

There is nothing in the 4010A1 implementation guide that would prevent a crossover claim from containing two 2320 Other Subscriber loops both indicating payment as primary.
Submission 3/30/2005
Status Date 6/27/2005
Status F - Final
Primary References
Document 004010X098A1
Section1.4.2
Page17
Set ID837P
Loop2000B
Segment Position005
Segment IDSBR
Element Position01
Industry NamePayer Reponsibility Sequence Number Code
Code ValueP