This sounds normal to me.  I submit a claim for a dollar amount and the
insurance company sends me a note saying "$0.00 coverage has been approved".
Sorry, I could not resist.
Donnie
----- Original Message -----
From: kathy carll <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, January 17, 2003 9:04 AM
Subject: [HP3000-L] HSS Pricer module


> Here at Harvard Pilgrim we are encountering a problem where some Medicare
> (HCFA)hospital DRG claims are being paid with $0.00 when they are re-
> adjudicated through the HSS pricer module.   They are grouping fine.
>
> The claim has:
> - a DRG value in the claim header (returned from the HSS grouper)
> - a HCFA pay code(09) on at least 1 of the service lines (usually on line
> 100)
> - payable status (not denied).
>
> It seems as though the AMTPAY field on DRG hospital claims claims is being
> zeroed out when the claim goes through batch readjudication, BCP0500.  We
> know that the claim has the proper AMTPAY before batch adjudication, then
> once it is run through batch readjudication (which includes HSS
> Grouper/Pricing processing), the AMTPAY values are zeroes out.  We suspect
> that the HSS processing has something to do with this problem, but we can
> not recreate the problem in our test environment - perhaps there is a
> contention issue with the HOSPRATE and/or DRGRATE KSAM files.
>
> Has anybody encountered anything like this?
> Any feedback or theories will be appreciated.
>
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