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Back  RFI # 1217: 835 Reversal and Corrections

Formal vs. Informal Help Informal Formal

Submitter

Mary Ann Zelko

Description

Section 1.10.2.8 Reversals and Corrections states when the claim adjudication results have been modified from previous reporting, the method for revision is to reverse the entire claim and resend modified data.

The original adjudication of a claim was returned in a paper remittance advice as the provider did not previously receive an 835. The provider now receives an 835. That original claim has been modified and readjudicated. Is it a requirement to generate the 22 reversal record for the old claim that originally went out on paper? Or is it acceptable to just report the new adjudication record?

A similar question. If only one day of a multiple day claim was modified, is it acceptable to reverse the one day (22 reversal record) and submit the correction (1 Primary record) for only the single day rather than the whole claim?

Submitter Assigned Keywords

835 reversal requirement

Response

For the situation where the remittance was communicated via paper the payer has the data and should convert that to a reversal transaction converting internal proprietary codes to standard codes.

For the one day correction of a multi day claim the answer is the entire claim containing multiple days must be reversed and then corrected. See 1.10.2.8 and claim balancing for additional guidance.
Submission 12/30/2010
Status Date 3/11/2011
Status F - Final
Primary References
Document 005010X221
Section1.10.2.8
Page29
Set IDCLP