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Back  RFI # 615: Write off overpayment recovery

Formal vs. Informal Help Informal Formal

Submitter

LYNN YAMASHIRO

Description

When a provider has refunded a portion of the overpayment but not the entire overpayment amount, the 835 must contain this difference in the PLB segment. If the payer would like to write-off the remaining balance rather than carry forward the balance, what code would be appropriate to use in PLB03-1?

Submitter Assigned Keywords

835 PLB

Response

This is not specifically addressed in the 4010A1 implementation guide.

Recommendation

The recommendation from the workgroup if the payer wants to not collect the funds from the provider is to create an offsetting CS adjustment. There would be a WO overpayment amount identified (amount to be recovered), this money amount would be positive, then a CS adjustment (amount payer will write off) this would be a negative money amount to offset the positive. The Reference identification should reflect “Payer write off” so the provider knows why the adjustment was made and no further action is needed on his part.
Submission 12/4/2007
Status Date 2/6/2008
Status F - Final
Primary References
Document 004010X091
Section3
Page165
Set IDPLB03
Segment IDPLB
Element Position03
Component Position1
Industry NameProvider adjustment reason code