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Back  RFI # 697: Corr Priority Payer Name Use

Formal vs. Informal Help Informal Formal

Submitter

stacey alsdurf

Description

The usage note for the Corrected Priority Payer Name segment in the version 4010A1 835 implementation guide says "This segment is required when the current payer believes that another payer has priority for making a payment."

Is the intent of this segment to indicate when the payer did NOT receive prior payer payment information and they are informing the provider that the patient has other coverage OR
Is the intent of this segment to always send the prior payer information that the current payer has in their records regarding a patient, regardless of whether the 835 data reflects the prior payer payment information or not. For example, the current payer reflects an adjustment with group code OA and claim adjustment reason code 23 indicating that they are aware of a previous payer and they are recording that payer's payment on the 835. Would the current payer still send information on the 835 regarding this payer?

Submitter Assigned Keywords

COB priority payer

Response

This issue is explicitly addressed in guide 004010X091. The busniess name for this segment is "Corrected Priority Payer". This segment is used ONLY when the current payer is providing corrected information - another payer has priority and should adjudicate the claim before this payer will adjudicate the claim for possible payment. When the prior payer(s) have already adjudicated the claim and their adjudication results have been supplied (i.e. a CAS with CAS01=OA and CAS02=23 is sent) this segment does not apply to the claim and therefore wouldn't be sent.
Submission 10/10/2008
Status Date 10/29/2008
Status F - Final
Primary References
Document 004010X91A1
SectionNA
Page116
Set IDNA
Table2
Loop2100
Segment Position030
Segment IDNM1
Industry NameCorrected Priority Payer Name