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Back  RFI # 495: Secondary Claim and Bundling

Formal vs. Informal Help Informal Formal

Submitter

Ryan Wexler

Description

While the 4010 guide does not include secondary claim instructions explicitly, I have run into a problem with a secondary claim that includes bundling. The secondary 837 requires that the primary payer bundling be reported. If the secondary payer bundles the same way, which
adjustment should be reported on the secondary 835's bundled lines that do not pay? The one related to bundling, or the one related to the
primary payer?

bundling - CAS*CO-or-PI*97*$$$
or
Secondary - CAS*OA*23*$$$

Response

The instructions that should be followed are the bundling instructions in section 2.2.6 of the 835 004010A1X091. When reporting secondary payments in the 835, the payer reports the impact of the primary payer's payment upon the secondary transaction. In this case, the secondary payer would report the amount not paid due to bundling with CAS*OA*23*$$$. Since the primary adjustment has already been posted, using CAS*CO-or-PI*97*$$$ would create a credit balance in the provider's account receivable system.
Submission 12/4/2006
Status Date 3/14/2007
Status F - Final
Primary References
Document 004010X091A1
Section2.2.6
Page25
Set ID835
Secondary References
RFI ID 444
Document 005010X221
Section1.10.2.1
Page38
Set ID835