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Back  RFI # 736: Late Submissions and 835s

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Submitter

Talitha Pettepher

Description

A payor recieves an 837I for Late Charges. Should this be treated as an additional original claim or as an adjustment to the originally submitted claim?

In either choice of treating the incoming claim, should the Late Charge 837 be reflected on an 835 as the submitted Late Charges Only or should it be combined with the original claim (previously reported on an 835) so that the 835 for the 837I Late Charge reflects the total original plus the late charges?

Response

The Late Charge (Bill Type Frequency Code) is defined in the UB04 manual as "charges submitted to the payer, which were received by the provider after the Admit Through Discharge, or the Last Interim Claim has been submitted.

Note: This code is not intended to be used in lieu of a Replacement
Claim"

As this is not a replacement claim, it could be treated by payers as either an additional original claim, or as an adjustment to the originally submitted claim, but not as a complete replacement for the original claim.

Late Charges submitted with a new CLM01 value that is different from the original claim, would be handled as an original claim with its own unique CLP01 value being returned in the 835. Payment would be based upon the total value of the claim and an 835 sent accordingly. If the late charges have the same CLM01 value as the original claim, the payer may use the reversal & correction process.
Submission 3/10/2009
Status Date 6/2/2009
Status F - Final
Primary References
Document X096A1
SectionCLM
Page157
Set IDCLM05
Loop2300
Segment IDCLM
Element Position05
Component Position3
Industry NameClaim Frequency Type Code
External Code List235