RFI Browser

Back  RFI # 1385: Returned Checks

Formal vs. Informal Help Informal Formal

Submitter

Kim Bugg

Description

In some cases, after we pay a claim the provider sends us a check returning the payment with a statement that the original claim was in error and should not have been submitted. In the 835 should we reverse the claim, not provide a correction since the claim is now cancelled by the provider, and report the check received in the PLB using adjustment code 72, or not report anything in the 835, or something else?

Response

There is no requirement under the guide to provide acknowledgement of the check received. However, from a general business perspective, providing that acknowledgment is consistent with the principles described within the Balance Forward and Overpayment Recovery sections of the guide. See the recommendation section for suggestions on how to report this information.

Recommendation

If a health plan desires to acknowledge receipt of the check, then the contents of the PLB depend upon the details of the refund. Per section 1.10.2.17, "...the health plan will acknowledge the receipt of the check using the PLB segment of the next 835. In order to maintain a balanced 835, this is accomplished using offsetting adjustments in the PLB. PLB03-1 codes 72 (Authorized Return) and WO (Overpayment Recovery) are used."
Submission 8/18/2011
Status Date 12/8/2011
Status F - Final
Primary References
Document 005010X221
Section1.10.2.8
Page29
Set ID835