Effective with the 4/19/19 Health Care Claim Payment/Advice (835), MO HealthNet implemented a required system change to correct what is reported as the submitted line item charge on the 835 for crossover claims. This will affect 837I (Institutional; Outpatient, Nursing Home, Inpatient, etc.) and 837P Professional (Medical, Dental) claim types.
MO HealthNet is following the HIPAA compliance guidelines outlined in the ASC X12 Health Care Claim Payment/Advice (835) version 5010 TR3 Section 1.10.2.1.1. This will report the line Item charge amount (from 837I SV203 or 837P SV102) which was submitted by the provider on the claim to Medicare and forwarded to MO HealthNet versus using the total of the patient responsibility (PR) amounts from the explanation of benefits (EOB) to populate the 835 SVC02 field. This will result in more line items having adjustment amounts, reported as contractual obligation (CO) 45, to account for the difference between the submitted line item charge amount and the MO HealthNet paid amount.