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Back  RFI # 2075: 835 Relationship to payment

Formal vs. Informal Help Informal Formal

Submitter

Pamela Grosze

Description

Providers are reporting that payers continue to send one payment (check or EFT) that has multiple 835s that comprise the remittance advice detail for the payment, or the reverse - multiple payments (check or EFT) that are rolled up into one 835. Either of these scenarios causes extreme difficulty in reassociating the payment(s) to the remittance advice. Is it valid for a payer to produce multiple 835s for one payment or multiple payments for one 835?

RFIs 217 and 594 appear to be related to this issue.

Submitter Assigned Keywords

835 EFT TRN02 Payment Reassociation

Response

According to the X12 835 TR3, the total amount of payment transmitted in the health care EFT must equal the total amount of payment indicated on an associated ERA. If a health plan does not comply with this implementation specification, then re-association will be difficult.

The 835 Technical Report Type 3 (TR3) contains multiple references to the fact that there is a one to one relationship between the payment and the 835 transaction set.

The following sections from the ASC X12 005010x221A1 835 TR3 clearly reference the requirement regarding this relationship:

1.10.1.1 Payment
One 835 transaction set reflects a single payment device. In other words, one 835 corresponds to one check or one EFT payment. Multiple claims can be referenced within one 835.

1.10.1.4 Remittance

The 835 must be balanced whenever remittance information is included in an 835 transaction. For a balanced 835, the total payment must agree with the remittance information detailing that payment. The remittance information must also reflect an internal numeric consistency.

1.10.2.2 Remittance Tracking

NOTE
Due to the need for remittance tracking, there is a one to one relationship between any specific 835 and the related payment mechanism (check or EFT). One 835 must only relate to a single payment mechanism and one payment mechanism must only relate to a single 835. The only exception is a non-payment 835 (BPR02=0) where there is no associated payment mechanism.

TRN – Re-association Trace Number Segment ASC X12 835 5010x221 TR3
TR3 Note: This segment’s purpose is to uniquely identify this transaction set and to aid in re-associating payments and remittances that have been separated.

TRN02 Element Note: This number must be unique within the sender/receiver relationship. The number is assigned by the sender. If payment is made by check, this must be the check number. If payment is made by EFT, this must be the EFT reference number. If this is a nonpayment 835, this must be a unique remittance advice identification number.
Submission 7/17/2015
Status Date 10/9/2015
Status F - Final
Primary References
Document 005010X221A1
Section1.10.2.2