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Back  RFI # 1883: 835: Payer Use of PER*CX Seg.

Formal vs. Informal Help Informal Formal

Submitter

Chris Weber

Description

Hello,

As a software vendor we are finding that a payer's utilitizing the Claim Contact Information Segment- PER*CX (PER02), to identify when a payer has issued a recovery payment and adjustment within the 835 file with an unexpected data. The following is being returned:RETRO RATE REVERSAL/ RETRO RATE CORRECTION.
examples:
PER*CX*RETRO RATE REVERSAL*TE*8009999999~ with claim status 22

PER*CX*RETRO RATE CORRECTION*TE*8009999999~ with claim status 1.

Is this a compliant Segment to use to identify this data?


Thanks,
Chris Weber
cweber@nextgen.com

Submitter Assigned Keywords

835 Payer Use of PER CX Seg.

Response

The 0050X221A1 835 PER segment Situational Rule states: Required when there is a claim specific communication contact. If not required by this implementation guide, do not send.

Reporting anything other than a contact information in the PER segment is not permissible as specified in the second sentence of guide section 1.8, "A trading partner agreement must not override the specifications in this implementation guide if a transmission is reported in GS08 to be a product of this implementation guide.".

The information that the payer is populating should be reported by a Remittance Advice Remark Code (RARC) as well as in the CLP02 that uses the appropriate claim status code.

There are many RARCs that provide additional information about a reversal and correction.

Refer to RARCs N419 through N423 that were created in 2007. A new set of codes were added that offer more detail: N687 through N698.
Submission 11/25/2013
Status Date 1/31/2014
Status F - Final
Primary References
Document X12.22
Section1.1
Page180