837 Coordination of Benefits Requirements For Anthem Partners
837 Coordination of Benefits procedure described in the blog refer to the 837 Health Care Claim transaction requirements. The 837 Coordination of Benefits data elements work together to coordinate benefits between the East Region and Medicare or other carriers. The East Region recognizes submission of an 837 transaction to a sequential payer populated with data from the previous payer’s 835 (Health Care Claim Payment/Advice). Based on the information provided and the level of policy, the claim will be adjudicated without the paper copy of the Explanation of Benefi ts from Medicare or the primary carrier. When more than one payer is involved on a claim, payer sequencing is as follows:
- If a secondary payer is indicated, then all the data elements from the primary payer must also be present.
- If a tertiary payer is involved, then all the data elements from the primary and secondary payers must also be present. If these data elements are omitted, the East Region will fail the particular claim.
837 Coordination of Benefits And Claims Attachments
To expedite processing of a claim:
- If you are sending an attachment to support a claim, populate Loop 2300 PWK02 with a value of ‘BM’ (By Mail).
- Download the Attachment Face Sheet from www.anthem.com/edi
- Mail the attachment to the appropriate address listed at the bottom of the Attachment Face Sheet on the same day the claim is submitted.
- Do not send a copy of the claim with the attachment.
- Send the completed Attachment Face Sheet with the attachment.
The Attachment Face Sheet includes the following fields:
- Date Claim Transmitted
- Line of Business (Professional, Institutional)
- Member’s Contract Number (Including Prefi x)
- Patient Name
- Date of Service
- Provider Name
- State Where Services Were Rendered
- Identifi cation Code. This is the Attachment Control Number, an alphanumeric code created by the provider for his records.
837 Coordination of Benefits and Claims all documentation must be received within 7 calendar days of the electronic submission. If supporting documentation is not received but is required to process the claim, the East Region will deny the claim.