If sending a reversal for a claim/service that was originally reported with a Health Care Policy ID, are we obligated to include the health care policy ID in the reversal?Also, if we sometimes report health care policy IDs (when they apply), and then use a CARC that refers to a health care policy ID, are we obligated to report some health care policy ID if none applies in that specific instance?
There is no set requirement in theTR3 that requires that you send the HCP segments in the reversal transaction. There is also nothing that states that you must not, so it is a business decision whether to send this data in the reversal transaction.The reason for the reversal transaction is to reverse the financials in the providers system and not reversing based on policy so inclusion of the policy in the reversal would not be necessary for the provider as the reason for reversing the transaction.You may use a CARC code that has the Health Care Policy message on it without supplying the HCP REF segment if it does not apply to that instance.