Section title: Requests for Interpretation
RFI #
2544
Using a 835 to report Non-Claim Payments to All Payer Claim Databases (APCDs)
Description

Is it possible to use the 835 to report non-claim payments for providers to an All Payer Claims Database or other reporting entity? It is not possible to report these payments on the Post Adjudicated Claims Data Reporting (PACDR) 837 since they are not associated with a claim or encounter. Is there anything that needs to be done within the 835 to report these payments for all the providers a payer has made non-claim payments?

RFI Response

The 835 can report non-claim payment data using tables 1 and 3. Table 2 is specific to claims and would not be used.  The 835 must balance and meet compliance for all data elements.

Scenario

All Payer Claim Databases (APCDs) want to receive non-claim payment information to have a fuller view of health care spending than they have with receiving just the PACDR 837.

DOCUMENT ID
005010X221