Questions Submitted by the Public, by Date Posted to the Website. Line maximums and split claims

11/02/2001

If a payer's adjudication system cannot handle 999 lines for institutional claims or 50 lines for professional and dental claims, can they accept the claim in their pre-processing system, and then split the claim for processing in their adjudication system with the number of lines the system can handle?

5/14/2001:

Yes.


Would they then follow the rules in the 835 Implementation guide for reporting back split claims?

5/14/2001:

Yes.


Would this be allowable under the HIPAA regulations?

5/14/2001:

Yes

 


If the payer had a COB trading partner agreement, and split the claim for processing in their adjudication system, would they have to reassemble the original claim, or could they forward the split claim to the secondary payer?

5/14/2001:

No, they could forward the split claim.