Section title: Requests for Interpretation
RFI #
2325
Reversal and Correction Method
Description

We have a payer that we think is doing reversals and corrections improperly. We sent a claim with three procedures. Two of them paid, one of them denied. We fixed the claim, and send a corrected claim. They send the 835 with no reversal, and had payments on all 3, so they didnt do a split claim. They sent a positive payment for the one that originally denied. For the two that originally paid, the sent $0.00 payments with an N702, OA-96, and CO-45. Since they didnt do a Reversal and Correction, or split the claims, so i believe they are doing this against the spec.

Response

The process for reporting a payment from a corrected claim is described in the reversal and correction process in Section 1.10.2.8 Reversals and Corrections.
Reporting N702, OA 96 and CO 45 for the previously paid lines is not correct. Instead the service lines are to be reported in the reversal claim (CLP02=22) with all original amounts reversed per the directions.

DOCUMENT ID
005010X221