This question is related to RFI #1874.
What is the correct number to be used in TRN02 for "check number" when the check / payment is sent to the patient instead of the practice? Can health plans include an incorrect check number if the check was sent to the patient?
If a health plan makes a payment to the patient instead of the provider with PR100 (PR = patient responsibility; CARC 100 = Payment made to the patient), should the actual check number made to the patient be included on the ERA?
Health plans fail to include the correct check number that was sent to the patient. This creates a number of problems. First, often the patient assigns benefits to the practice but some health plans have policies that do not honor the assignment of benefits. A patient has a balance and usually will send the check they received to the physician's practice or sometimes deposit it and write their own check for the same amount. Patients also rely on physician billing staff to appeal underpaid or denied claims and to deal with administrative problems such as non-payment. Often when we call to inquire about payments, insurance company staff asks for check number.
Knowing the check number is often needed to assign payment correctly to the correct claim if a patient has multiple identical claims (such as repeat visits with the same CPT).
See Section 188.8.131.52 Remittance Tracking. The TRN (Trace Number) is a unique number for business purpose between the payer and the payee. In the 835 ERA transaction the 1000B loop is the payee. The term “payee” is the entity receiving the 835 ERA, the actual providers and/or their agents (refer to section 1.1 of the 835 005010x221 guide paragraph 4 and section 1.4 paragraph 1)
In the scenario where the member paid, the actual check number is not required to be reported in the TRN02. The TRN02 for reassociation purposes must be the check or EFT number that was sent to the payee. As the member is not the payee, the check number is not required. The TRN02 must be a unique number, the guide does not prohibit the payer from using the member’s check number in the TRN02 as the unique number, but it is not required by this guide.
Related RFIs: 1874, 2369, 2287