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Back  RFI # 496: Secondary Clm & Bundling 2

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. When the secondary payer does not bundle and pays on the separate lines, there is a posting problem for the provider - those lines were written off by CO or PI adjustments from the primary. How should the secondary payment be reported in this case? Separately on the individual lines or on the combined (bundled) service that the primary adjudicated?

Submitter Assigned Keywords

bundling cob

Response

The secondary payer follows their own business rules. Therefore, a secondary payer does not need to adjudicate their payment based upon how the primary payer processed the charge or report it in the 835 based on the primary payer’s 835.
In the case specified, the secondary payer would report payment based on the Individual submitted lines.
However they are obligated to report the impact primary Payers adjudication including payments and/or adjustments (OA*23).
Submission 12/4/2006
Status Date 3/30/2007
Status F - Final
Primary References
Document 004010X091A1
Section2.2.6
Page25
Set ID835