RFI Browser

Back  RFI # 1386: Overpayment Recovery

Formal vs. Informal Help Informal Formal

Submitter

Kim Bugg

Description

We use the Reverse and Corrections process to do overpayment recovery and sometimes delay recoupment as allowed in section 1.10.2.17 option 3. In some cases, we do a second charge (deduction) to a claim before the first charge has been recovered. This would mean two recoveries for differnt amounts but with the same claim#. Does the 835 require that both recoupments be the same ID in PLB02-02 or can these be different in some way? If different do you have any recommendation?
(Note to self: applicable if bus decision is made not to split the claim internally.)

Submitter Assigned Keywords

Overpayment recovery

Response

Section 1.10.2.17 indicates for option 3 the PLB03-2 must be the CLP07 value of the claim being refunded and 'delayed'. So if the same claim number is used for all adjustments related to a specific claim, then both recoupments would use the same ID in PLB03-2.

The guide is silent as to what should be reported when the money is actually offset in a future 835 - meaning 1 PLB03-2 with the combined refund amount or 2 PLB03-2s (each with the same ID - CLP07 value) and the corresponding dollar amount for each recoupment on the specific claim.

If a payer must wait a specified time frame to actually recoup the money, then option 3 would indicate 2 PLB03-2s (each with the same ID - CLP07 value) and the corresponding dollar amount for each recoupment on the specific claim, but they would probably be reported on different 835s given the difference in 'waiting periods' associated with each adjustment.
Submission 8/19/2011
Status Date 10/17/2011
Status F - Final
Primary References
Document 005010X221
Section.10.2.17
Page49
Set ID835