Section title: Requests for Interpretation
RFI #
2369
Discrepancy in 835 Payment Ref
Description

Health plan sends an 835 ERA that lists an incorrect payment check number. The payment is sent by mail as a paper check. The check number does not correspond to the payment check number listed on the 835 ERA transmission. Is it permissible under any circumstances for a health plan to transmit invalid check numbers or payment reference numbers, or payment re-association numbers on an 835 ERA? Is it permissible under any circumstances for the payment number reference number (check number or ERA re-association number) to be non-reconcilable to the actual payment number (check number or EFT reassociation number 835 TRN segment)?

Response

Draft Response:  It is NOT permissible. The TRN02 element note clearly states: If the payment is made by check, this must be the check number. If payment is made by EFT, this must be the EFT reference number. Section 1.10.2.3 – Reassociation of Dollars and Data covers this subject in detail. The purpose of the TRN segment is to allow the provider to match their payment to their remittance.

RFI Recommendation

See also RFI # 1874 and RFI # 2075, #2287

DOCUMENT ID
005010X221