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Back  RFI # 1350: 835 v4010A due from patient

Formal vs. Informal Help Informal Formal

Submitter

ann walton

Description

Is it consistent with the 835 guide to report the primary payer's
payment to the data field designated for the provider's billed
charge on the 835 remitance, version 4010A? Also, is it consistent with the 835 guide to report more than $0 to the
paitent responsibility data field where the primary payer has paid in full?

Submitter Assigned Keywords

4010A 835, patient responsibility, provider charge, primary payment

Response

We interpret your inquiry as 2 independent questions. If you are referring to a single circumstance that includes both scenarios, please respond with a detailed example.

Regarding the primary payer's payment, no, it would not be reported in the data field designated for the provider's billed charge. The provider's billed charge is reported in the CLP03 segment and the primary payer's payment is reported in CLP04.

Regarding the patient responsibility amount, no, the value in that field would not exceed $0 if the primary payer has paid in full. If the provider billed $100, and the primary payer paid $100, then what would be left as the patient responsiblity? Any non-zero amount in that field would throw the transaction out of balance. See front matter section 2.2.1 Balancing in the 835v4010A1 guide. Also, though you are specifically questioning version 4010A1, you may find the 5010A1 guide's front matter section 1.10.2.13 Secondary Payment Reporting Considerations helpful.
Submission 6/29/2011
Status Date 8/26/2011
Status F - Final
Primary References
Document 835 v4010A
SectionI