Section title: Requests for Interpretation
Creating 835 when Payment is made to the Member

Requesting guidance on the creation of 835 including BPR04 and TRN02 when claim payment is made directly to the member and not the provider who submitted the claim.  Should BPR04 = NON  in this case because no money is being moved to the provider and this remittance information is informational only?  Is there any requirement to provide a subscriber issued check number back to a provider on the 835?


Provider submits 837 to Payer A for a member of Payer B.

Payer A sends the claim to Payer B

Payer B sends Payer A a disposition of the claim with amounts but not including subscriber check number or date.

Payer B Pays the member directly via Check due to the provider being non par

Payer A creates an 835 back to the provider

Is there a requirement for Payer B to provide the check details to Payer A to include on an 835 created for the provider?

RFI Response

In this situation, the BPR04 (Payment Method Code) would report a value of NON.  The TRN02 (Reference Identification) would report a unique remittance advice identification number and not a check number since this is a nonpayment 835.   

There is no segment/data element in 835 transaction to report a check number that was sent to an entity other than the provider receiving this 835.  Example check is sent to the member, an employer, an attorney. 

The CARC will relay the message that the check was sent to a different entity.  

100 – Payment made to patient/insured/responsible party.

293 – Payment made to employer.

294 – Payment made to attorney.