Providing a high level focus on the process leading up to the filing of secondary or tertiary Professional Health Care Claims, this Washington Publishing Company course includes a detailed review of the code lists involved.

• Professional provider or billing service staff involved in posting of health plan payments, creation of secondary electronic claims, or denial management functions.
• Health Plan staff involved in secondary or crossover claims review, or claims adjudication or remittance formatting

• Review the history of health care electronic remittance advice formats
• Explore what is different about the 835
• Look in general at key 835 business issues, structures and requirements

• Review the function of the 837P
• Review the general structure of the 837P
• Describe the purpose of the segments in the 837P
• Identify references to important business sections of the IG

• Review code sets critical to reporting other payer’s payment details
• Review the details of other payer payment structures in the 837P
• Discuss mapping from paper/proprietary remittance advices into the 837P

• Accounting for Charges
• What NOT to post
• What to post

• Understand the message reported by payers in the electronic remittance advice
• Identify the standard code lists directly involved in reporting primary payment information in a secondary claim
• Find the code lists on the internet

• Understand how to use the codes to convert proprietary coding from a paper remittance advice into the standards
• Identify the locations for primary payer information in the HIPAA electronic professional claim