When I read "refunds" I thought of refunds to health plans for provider payment adjustments or provider duplicate payments, and COB recoveries between health plans.
Are these matters covered elsewhere or not at all? Thanks for any response. Si -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Thursday, October 11, 2001 2:24 PM To: [EMAIL PROTECTED] Cc: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: Refunds Thanks Julie for the response. I had in mind provider refunds.. should have been more clear. I had up till now not thought about the refund process nor . If refunds to providers are not considered in the 835, it appears that it would leave a hole in the electronic process. I was trying to asses whether others agreed with that opinion or not. Thanks! Jonathan Showalter Omaha NE USA 402-343-3381 [EMAIL PROTECTED] ------------------( Forwarded letter 1 follows )--------------------- Date: Thu, 11 Oct 2001 09:50:41 -0400 To: JONATHAN.SHOWALTER, [EMAIL PROTECTED], [EMAIL PROTECTED] From: Julie.Thompson[julie_a_thompson]@hotmail.com Subject: Re: Refunds Good questions, Jonathan! Since no one has answered, I thought I would give it a shot. I will assume you are referring to "Patient Refunds". Under New York and New Jersey state legislation, there is a requirement to notify both patient and provider regarding all payments. It is safe to say, this would include notification to all parties for payment adjustment and corrections. Other states may not have this requirement. HIPAA requires payment notification to the provider, even when the payment to the provider is 0.00 (captitated services), or when any adjustments or corrections are made. Also, there is a summary amount for patient payments. The description on page 250 of the 835 Guide Data dictionary for Total Patient Reimbursement Amount, Loop 2000, Segement TS322 describes the element as the total of all patient refund amounts. The element that would be sued to accumulate this amount should be Loop 2100, AMT02. Technically, this should work properly. The guide could use some greater clarity on this process. Julie A. Thompson the remittance itself From: [EMAIL PROTECTED] To: [EMAIL PROTECTED], [EMAIL PROTECTED] Subject: Refunds Date: Tue, 9 Oct 2001 10:20:00 -0500 I posted this question last week but did not get any response. I thought I would try one more time. I wanted to ask the group if any of you are thinking about how you will handle refunds and whether or not refunds should produce a correction and reversal 835. The 835 might be sent to reflect the refund once it has been received by the payor or as a device to notify the provider that a refund should be made, etc.... or do you think refunds fall outside of the 835 process? Thanks! Jonathan Showalter Omaha NE USA 402-343-3381 [EMAIL PROTECTED] ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request.
