Section title: Requests for Interpretation
RFI #
2352
835 TS3 by mutual agreement
Description

The TS3 situational rule states “..or when payers and payees outside the Medicare Part A community need to identify provider subsidiaries whose remittance information is contained in the 835 transactions transmitted to a single provider entity [i.e., the corporate office of a hospital chain]. If not required by this implementation guide, do not send.” We interpret this to mean that the payer and payee mutually agree to use the TS3 segment for the stated business condition. Is our interpretation correct? Thank you.

Response

Yes, your interpretation is correct. For non-Medicare A entities, the TS3 is used to group claim payment information by subsets of the payee provider entity (for example, payment made to a corporate office, with claim payment information grouped by separate NPIs within the hospital chain).  When both parties agree (payers AND payees), the TS3 can be used for this purpose.

DOCUMENT ID
005010X221