Void check situation where the provider is sending back the payer check and disputing certain claim adjudication results instead of cashing the check and then appealing the claims in question.
How would we report the claims and voided check in this situation? Since an 835 had gone out originally would you need to report a reversal of those original claims and then the corrected claims? Or, since the provider sent the check back does it automatically mean they would be required to manually remove the claims from the original 835 transaction from their accounting systems and we just report the new/corrected (Reprocessed claims)? If the latter is the case then would you need to report the REF*F8 with the original CLP07 values from the voided transaction? (each claim processing in our system will assign new payer control # )
Submitter Specified Prior Related RFIs 1385
This is not specifically addressed in the 835.
Any payment dispute between a provider and a payer should involve appropriate communication between the parties utilizing methods outside the 835 transaction.
Once the parties have agreed to the method for correction, whether to use or not use the reversal and correction process depends upon whether or not the provider has posted the original adjudication to their system and the payer can regenerate the data accurately in an 835. If the check was returned and no posting took place, then usage of reversal and correction would be inappropriate. Sections of the guide that provide additional information that may be useful include 1.10.2.3.1 and 1.10.2.8.