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Back  RFI # 967: Unbundling Sales Tax

Formal vs. Informal Help Informal Formal

Submitter

Jill Santavy

Description

The 837 allows a service to be reported with the service and related sales tax on the same service line. Our system breaks that service into 2 lines, one for the service and one for the sales tax (HCPCS S9999). Can this be reported as an unbundled service in the 835, or does the definition of unbundling (Unbundling occurs when one submitted procedure code is to be paid and reported back as two or more different procedure codes.) preclude reporting this way in the 835 because one of the unbundled services is the same as the submitted service? Does this require recombining both into one line on the 835?

Response

This would not be considered unbundling as it was originally intended. The intent of the unbundling represented in the guide is when two different codes from the code submitted would be used.

Recommendation

It is the recommendation of the Workgroup that the Health Plan return the service line as it was submitted by the provider. This will aid in posting to the providers accounts recievable system. So if the line includes the sales tax the service line on the remittance should also. If the tax is broken out upon submission then it should be represented that way going out on the remittance.

Example:

Submitted amount of $100.00 with 6% tax equals $6.00 sales tax Total; $106.00 all on one line AMT will report the tax

If the allowed amount is $50.00 there would be a CO45 = $50.00

CO235 = $3.00

If there is some patient responsibility amount the tax will be proportionate to that Patient responsible amount. In this case since the PR amount is $25 the Tax is only $1.50.

PR 1= $25.00
PR235 = 1.50
CLP05 = 26.50 Total patient responsibility
CLP04 = $26.50 Paid amount ( pd 25.00 and 1.50 Tax)
Submission 2/22/2010
Status Date 8/26/2010
Status F - Final
Primary References
Document 005010X221
Section1.10.2.6
Page25
Set ID835