Hi Kathy:
The 835 replaces the check and remittance advice mailed by Health Plans and Pharmacy Benefit Managers to pharmacies. It can be used to initiate financial transactions (check issuance and EFT in a variety of forms) and send remittance data electronically. The 835 can be used to send money and data together through the banking system or separated, with money going through the banks and data going separately. The IG does a good job of describing these options although the focus is not on pharmacy payments. Today’s business practices include all paper payment and remittance advices and combinations of EFT, check and electronic remittance data delivery. One state we know sends a tape out to a pharmacy chain every two weeks and one check for every 63 line items since their system was set up to print one check per page. The 835 for electronic remittance information and electronic funds transfer will be a significant improvement over that practice.
Good luck.
Jim
Jim Moynihan McLure-Moynihan. Inc. 28720 Canwood Street Suite 208 Agoura Hills, CA 91301 818-706-3882
-----Original Message-----
From the proposed modifications to the Transaction Standards published on May 31, 2002 in the Federal Register:
Therefore, we propose to modify the standard for the health care payment and remittance advice transaction for retail pharmacy transactions by adopting the ASC X12N 835 in place of the NCPDP standard. With the implementation of this proposal, the ASC X12N 835 would be the only standard for health care payment and remittance advice transactions. All covered entities, including retail pharmacies (Sec. 162.1602), would be required to use ASC X12N 835 when conducting a health care payment and remittance advice transaction.
Does anyone have any insight on what type of transactions these would pertain to? Some examples? Most pharmacies deal strictly with real-time online adjudication. From what I could tell from various docs on this, this standard deals with moving of funds to a provider's account - as the paying of Medicare Part A Institutional Claims.
From reviewing the specs and the WG5 Payment Reconciliation FAQ, this would not affect online claims adjudication. However some practical examples would be helpful.
Thanks!
Kathleen A. Neugebauer, R.Ph.
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- 835 Payment & Remittance & Retail Pharmacy Claims Kathy Neugebauer
- Re: 835 Payment & Remittance & Retail Pharma... Jim Moynihan
