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Back  RFI # 1455: 835 Service Line Reversal

Formal vs. Informal Help Informal Formal

Submitter

Cindy Monarch

Description

We have a payer who is rolling up multiple service lines into one service and reversing the total amount in the 2100 CAS (this is for the 4010A1 835). The provider is expecting the services lines to be reported as they were in the original 835 transaction at the service line and the reversal should look the same except for the amounts are reversed/negative. We have brought this to their attention citing the last bullet in section 2.2.8 but this payer disagrees with our interpretation. Please confirm if our interpretation is correct for 4010A1.

Submitter Assigned Keywords

835 Service line reversal

Response

This issue is explicitly addressed in guide 004010X091. Section 2.2.8 states "All original charge, payment, and adjustment amounts are negated." and "If the service line detail had been on the original payment, then the reversal should apply the same reversal logic to the claim and service lines."

Therefore, if the original adjudication did not bundle service lines, then the reversal must not bundle service lines. If the original adjudication reported service lines, then the reversal must contain the SAME service detail as the original adjudication, with the amounts negated. Your interpretation of the requirements is correct.
Submission 11/21/2011
Status Date 1/13/2012
Status F - Final
Primary References
Document 004010X091
Section2.2.8
Page29