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Back  RFI # 372: Charge increase on 835

Formal vs. Informal Help Informal Formal

Submitter

Randy Cloesmeyer

Description

While being adjudicated, claim charges can be increased as a result of a provider phone inquiry. Our 835 reports the original charges (in CLP03 and SVC02) and reflects the increases as a '94' adjustment. A particular provider wants the 835 to show the increased charges, not the original. We resist because we believe that our 835 is correct and that fulfilling their request would cause us be non-compliant. Can you render an opinion on this?

Response

It is the opinion of the workgroup that usage of CARC 94 is not appropriate in this instance.

The 835 was designed to allow for the auto-posting of remittance information. In order to maintain the integrity of the flow of data and not cause difficulty with a provider's accounting system, the provider should revise/ correct and resubmit the claim (paper or electronic) so that the correct amount is reflected in CLP03 and/or SVC02
Submission 1/3/2006
Status Date 3/8/2006
Status F - Final
Primary References
Document 004010X091
Section3.1
Page91
Set ID835