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Back  RFI # 889: Takeback & Recovery

Formal vs. Informal Help Informal Formal

Submitter

Sharon Sieve

Description

When a payer chooses to do takeback at account level and offset as PLB until later date is used. Can a provider choose not to post the account level takeback until the actual Recoupment occurs? We have a provider that wants to do to simplify tracking. Can they do this or do they have to post at the account level when the payer sends in the 835?

Exa 1
$ 100.00 Orig Pmt 010109
$<100.00> Takeback at account Level 030109 nothing posted, acct noted
$ 100.00 FB PLB 030109 nothing posted to gl
$ <100.00> FB Recoupment 050109 (account level transaction from 030109 posted
w/actual recoupment)

Submitter Assigned Keywords

Takeback & Recovery

Response

This issue is explicitly addressed in guide 005010X221. Section 1.1 states "The purpose of this implementation guide is to provide standardized data requirements and content for all users of ANSI ASC X12.835, Health Care Claim Payment/ Advice (835). This implementation guide provides a detailed explanation of the transaction set by defining data content, identifying valid code tables, and specifying values that are applicable for electronic claims payment. The intention of the developers of the 835 is represented in this guide.

This implementation guide is designed to assist those who send and/or receive Electronic Remittance Advice (ERA) and/or payments in the 835 format."

As such, this guide identifies the requirements for the transmission of EDI information, but not the actions taken by the receiver of that information. Any receiver of the 835 can act upon the conveyed information as they deem appropriate to their business.
Submission 10/12/2009
Status Date 11/11/2009
Status F - Final
Primary References
Document 005010X221
Section1
Page37
Set ID1.10.2