RFI Browser

Back  RFI # 1135: One or Two Remits

Formal vs. Informal Help Informal Formal

Submitter

Gladys Jones

Description

If a provider sends us two claims. Each claim has the same Billing Provider name and the same NPI, and the same Pay-To address, but the Billing Provider address on each claim is different. Are we to remit the claims in two separate remits with each remit having the same Billing Provider Name, NPI and Pay-To Provider or is the best practice to provide one remit including both claims?

Examples Below:
Address 1:
NPI = 123456789
Name = ABC
Addr = First Street
Pay-to = PO Box 100
Amount = $100.00

Address 2:
NPI = 123456789
Name = ABC
Addr = Second Street
Pay-to = PO Box 100
Amount = $200.00


Is the Best Practice Two Remits:
NPI = 123456789
Name = ABC
Addr = PO Box 100
Amount = $100.00

NPI = 123456789
Name = ABC
Addr = PO Box 100
Amount = $200.00

OR

Is the Best Practice One Remit:
NPI = 123456789
Name = ABC
Addr = PO Box 100
Amount = $300.00

Response

This issue is explicitly addressed in guide 005010X221. Section 1.10.2.2 states "Due to the need for remittance tracking, there is a one to one relationship between any specific 835 and the related payment mechanism (check or EFT). One 835 must only relate to a single payment mechanism and one payment mechanism must only relate to a single 835. The only exception is a non-payment 835 (BPR02=0) where there is no associated payment mechanism." In addition, the 1000B loop (Payee) only occurs once, allowing for only one payee address.

Therefore, if one payment (check or EFT) is generated, then one 835 is used. If two checks or EFTs are created, then two 835s must be used.

The determination of how many checks/EFTs are created is a business decision external to the 835. The address(s) used must be consistent with the business. In the case of a mailed check, the address reported in the 835 must match the address where the check was mailed.
Submission 8/20/2010
Status Date 9/14/2010
Status F - Final
Primary References
Document 005010X221
Section2
Page102
Set ID835
Table1
Loop1000B