Episode of Care with multiple primary Payer

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    • Type: Certification
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • Submit both primary payers using the Patient Characteristic Payer template, and each instance will have different effectiveTime/low and high to reflect the payer’s effective time.

      If an encounter is found to have 2 primary payers effective at one point of the visit, we are looking for guidance on which Payer information should be included in the QRDA I file. Could either payer be included? Thanks

      Example:

      Encounter begin on 3/1/2020 – discharged on 3/10/2020

      Payer #1 effective date 1/1/2020 – end effective date 3/5/2020

      Payer #2 effective 3/6/2020 – end effective date 12/31/2020  

            Assignee:
            Matthew Tiller
            Reporter:
            Isbelia Briceno
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              Created:
              Updated:
              Resolved: