Change Request Detail
No.
1147
Date
2/4/2011
Submitter
Type of Request
Payment of a Health Care Claim
Status
DSMO Process Completed
Business Reason
Some Medicaid payers always report their payments as a tertiary status even though the claim was submitted how the claim was actualy submitted.
Suggestion
The SBR segment of the 837, tells how you are submitting claim (primary, sec, tertiary). The 835 should have the same status.  This should be consistent. 
DSMO Category
D
Recommendation
Disapprove.  The 004010/005010 835 CLP02 has specific values the payer is to use when reporting how they are paying the claim.  We recommend that the requester work with the specific Medicaids to address this concern.

Appeal Recommendation