I have a question concerning the reporting of claim adjustments on the 835 transaction: I represent a health insurer and sometimes, a correction to a claim that has already been paid is submitted by the provider and results in an amount owed back to us. We currently do not have an automatic offsetting process in place. Instead, the reimbursement request is handled manually by a Refunds department, and the payment, when and if it is received, may be spread out over time in installments. Also, business decisions or contract provisions may cause us to discontinue the transaction, writing off the amount.
Is anyone aware of a method to report these treatments on the 835 transaction? That is, is there a procedure or transaction code that would enable us to acknowledge an amount to be written off or that is pending payment? The 835 will not allow us to display a negative total payment amount (BPR02) for a provider. I would appreciate any thoughts or leads. Thank you Kevin McAcy Systems Analyst Blue Cross Blue Shield of Nebraska x. 3535 Email: [EMAIL PROTECTED]
