Hi everyone ! There seems to be some ambiguity with respect to 271-835-837 ralationships for capitated Payments.
IG for 835 page number 31 states following: Capitation and Related Payments or Adjustments: The 835 is used to provide financial notification of capitation payments from a Managed Care Organization (MCO) to a capitated care provider. The 835 does not contain the capitation details or membership roster. Use an associated Eligibility and Benefits Notification Transaction Set (271) to communicate these details. IG for 270-271 deals with capitation in segment EB01 (Data element number 1390, page number 219.) REQUIRED EB01 CODE DEFINITION > 2 Active - Full Risk Capitation, 3 Active - Services Capitated. "Can anyone coding 835-271 for capitated payment at Insurance Co. clarify what relationships 837-835-271 will have for such special cases?" 1) Are 837 encounters required for capitated payment cases or claim is required to be generated? 1.1) If claim is required will it be with zero values? 2) Are 835 and 271s sent on fix dates to providers based on Trading Partner Agreement ? What is the current Practice? 3) Is Payment information is sent in single 835 file ? 4) Is Capitation details sent via 271 in a single file ? Thanks in advance. Deepan To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address. The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
