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Back  RFI # 497: Rptg Secondary Unbundled clms

Formal vs. Informal Help Informal Formal

Submitter

Ryan Wexler

Description

The example in the guide does not balance within each 2430 loop (only balances for all related loops) or match the bundling instructions in the 835 for how the primary payment would be reported. Are we correct that the adjustments reported in the 2430 loops must match the adjustments received from the primary in the 835 or must they match the CAS*CO*45 approach, which could never have been reported in the 835 for the added lines?

Response

It is correct that the adjustments (CAS segments) reported in the 837 must match those reported in the 835. The 4010X091 835 Implementation Guide, page 26, documents the same example you are inquiring about. The CAS segments in the 837 for this example should be reported as they are shown on page 26 of the 835 example.
Submission 12/4/2006
Status Date 3/14/2007
Status F - Final
Primary References
Document 004010X098A1
Section1.4.3
Page29
Set ID837P
Secondary References
RFI ID 447
Document 004010X091A1
Section2.2.6
Page25
Set ID835