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Back  RFI # 280: 835 and Consumer Driven Health

Formal vs. Informal Help Informal Formal

Submitter

Jodi Fekete

Description

We are implementing a CDH plan here at Horizon and want to ensure we are compliant with thedirection we are planning to take. After the claim adjudicates, we (the payer) will send out a check & 835 for the medical payment. Then, the claim information will 'spin' to the consumer paying system, and another check/835 will go out to the provider on a different day. The second payment will only show the line items of the charges that were paid/eligible by the consumer plan. Per the guide, are we in compliance with this?

Submitter Assigned Keywords

835 CDH

Response

There is no specific direction given for this scenerio in the 4010 835.

Recommendation

A check and paper remit is acceptable.
A check and an 835 from the HSA or payer is acceptable as long as the 835 is compliant according to the 4010 835 implementation guide and the transaction follows the rules of balancing as it is spelled out. Also if the claim was split for the purpose of payment from the HSA, the 835 must also follow the rules of claim splitting.
Submission 7/11/2005
Status Date 11/11/2005
Status F - Final
Primary References
Document 004010X091A1
SectionSVC
Page52
Set ID835