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Back  RFI # 791: 835 Reversals and Corrections

Formal vs. Informal Help Informal Formal

Submitter

John Murray

Description

While the rules for the CLP do not mandate any particular order and section 2.2.8 of the 835 4010X091A1 does not expressly prohibit posting the reversal and corrected payment in any particular order, section 2.2.8 does contain the following text:

"Reversal Method: Reverse the original payment, restoring the patient accounting system to the preposting balance for this patient. Then, the payer sends the corrected claim payment to the provider for posting to the account."

From this I would assume that a CLP segment containing the Reversal should appear in the 835 prior to one containing the corrected claim payment. Is this assumption correct, or are payors free to send the respective CLP segments in any order they choose, or even in seperate 835 transaction sets?

Submitter Assigned Keywords

correction reversal 835 remittance

Response

It is highly recommended that the reversal claim occur before the correction claim to avoid credit balances that will occur in the provider’s account receivable system if the correction is completed in a prior 835 than the reversal.

While the 4010A1 front matter does not explicitly say that the reversal should come before the correction the explanation and sequence of explanation should lend itself to assume the reversal must come before the correction.

A forward balance situation occurs if a reversal is completed in a separate 835 than the correction this should be avoided if at all possible.

Recommendation

The workgroup recommends completing the reversal and correction within the same 835.
Submission 5/28/2009
Status Date 9/14/2009
Status F - Final
Primary References
Document 835 4010x091
Section2.2.8
Page28
Set ID835
Table2
Loop2100
Segment IDCLP