Section title: Requests for Interpretation
RFI #
2362
835 dual coverage same plan
Description

How are payments expected to be reported when an insured has a dual coverage plan from a single carrier? For example, is the carrier expected to report back two separate claim payments, one processed as primary and the other as secondary?

Response

The 835 should reflect the claims based on how the payer adjudicated the claim. If the claim is processed twice, once as primary coverage and once as secondary coverage, and results in two payments, then each claim should have a Payer claim ID and be reported as 2 CLPs in an 835. If the claim is processed as a single claim then there is a single payment and reported as 1 CLP in the 835.

RFI Recommendation

Refer to RFI 2187

DOCUMENT ID
005010X221