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Back  RFI # 474: Claim Splitting and COB

Formal vs. Informal Help Informal Formal

Submitter

Ryan Wexler

Description

It is unclear how you implement cob when considering claim splitting with claim level adjustments. Let’s say you are sending cob to a tertiary. The primary sent you back an 835 with claim level adjustments for 4 service lines. The secondary split the claim and sends era for 2 of the service lines. When you send the cob for the claim consisting of the 2 service lines to the tertiary how can you possible report the previous payer eob data properly? The claim level adjustments from the primary payer apply to all 4 service lines, but you are now sending a claim to the tertiary only containing 2. So how are you suppose to properly communicate the data and make it balance?

Submitter Assigned Keywords

Claim Level Adjustments, COB, Claim Splitting

Response

In order to get the balance to work you would need to hold the claim until all 4 services lines have been processed by the secondary payer before sending to the tertiary.
Submission 10/24/2006
Status Date 1/3/2007
Status F - Final
Primary References
Document 837
Section004010X0
Page323
Set IDCAS
Loop2320