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Back  RFI # 170: FLAG CLMS AS HIST-ONLY ADJUSTM

Formal vs. Informal Help Informal Formal

Submitter

Henry Greene

Description

We are impl. hist.-only adj's and need to be able to flag on 835. This is for claims that have been thru audit and the outcome was that the prov. was truly overpaid, but the prov. alrdy returned $ in the past. We will adjust clm so hist. is correct, but not set up A/R since prov. has already returned $. What is best way to flag hist-only adj's on 835 so prov's will know no A/R's were set up? The Intrnl Ctrl # for these claims will distinguish them, but is there an ARC or some other way to flag them.

Response

This issue is not addressed in the implementation guide. There are no explicit requirements related to business situation of a history adjustment where there is no financial impact to the provider.

Recommendation

Since the Provider identified the overpayment and returned the monies to the Payer, the Payer must assume that the Provider already updated their Accounts Receivable. That said, sending a reversal and correction would cause a problem for the Provider's system. Therefore, there is no business or technical reason to report this claim again to the Provider using the reversal and correction process. This type of "History Only" adjustment does not get reported in the 835.
Submission 12/21/2004
Status Date 2/16/2005
Status F - Final
Primary References
Document 004010X091
Section3
Page95
Set IDCAS