835 Health Care Claim Payment/Advice - Cal-PM

Process an 835 health care claim payment or advice electronic file.

myAvatar PM > Billing > Remittance Processing > 835 Health Care Claim Payment/Advice

• Payments are distributed to claims or services with a remaining balance.
• This form works with the Claim Adjustment Group/Reason Code Definition form.

• The location to store 835 files must be defined in the Facility Defaults form (Output Path On Server For Electronic Billing field).

1. In the Options field select the action to perform on the 835 file:

• Select Load File to load the 835 file from the server. If the 835 file has the same name as a loaded 835 file, a message displays. Click Yes to load the 835 file and replace the existing file. Click No to cancel loading the 835 file.
• Select Compile File to compile a loaded 835 file. When an 835 file is compiled, the 835 information is placed in associated SQL tables. The 835 Pay Adj Errors report is generated.
• Select Run Report to generate the 835 Pay Adj Errors report.
• Select Post File to post a compiled 835 file. When the 835 file is posted, the file is edited to include the latest file information. Posted 835 files are removed from the Select File list 100 days after posting. The information contained in the 835 file remains stored in myAvatar PM.
• Select Dump File to generate a text file of the compiled file.
• Select Delete Loaded/Compiled File to delete an 835 file that has been loaded or compiled. When an 835 file is deleted, it can be compiled again through this form.

2. In the File Path/Name field, enter the file path for the 835 file.

3. In the Process Transaction Handling Code(s) field, select how claim status information will be added to the 835 file.

4. In the Posting Date field, enter the posting date.

5. In the Payment Code field, select the payment code. The payment code is applied to all cash payments in the 835 file.

6. In the Payment Reversal Code field, select the reversal payment code.

7. In the Date Of Receipt field, enter the payment received date.

8. In the Select File field, select the 835 file.

9. Click Process File. The 835 Payment/Adjustment Error report is generated.

► SQL Tables

• SYSTEM.billing_835_auto_log
• SYSTEM.billing_835_claim
• SYSTEM.billing_835_file
• SYSTEM.billing_835_file_info
• SYSTEM.billing_835_file_orig
• SYSTEM.billing_835_header
• SYSTEM.billing_835_pay_adj_history
• SYSTEM.billing_835_pay_adj_proc
• SYSTEM.billing_835_pay_rem
• SYSTEM.billing_835_rem_bal_tra
• SYSTEM.billing_835_service
• SYSTEM.billing_835_trailer
• SYSTEM.billing_835_tx_claim_info
• SYSTEM.billing_835_tx_svc_info

► Registry Settings

• Additional Service Determination Methods

• Allow For Optional File Description

• Check Number

• Compare All procedure Modifiers (2110-SVC-01/2110-SVC-06)

• Display Loaded/Compiled/Posted Files in 835 'Select File' Prompt

• Enable Claim Status Code 13

• Enable Claim Status Code 25

• Enable Crossover Payment Logic

• Enable Service Supplemental Amount Logic

• Include 'Patient Paid Amount' in 'Claim Patient Responsibility Amount'

• Multiple User Access to '835 Health Care Claim Payment/Advice'

• Perform EFT Trace Number (TRN-02) / Payer Identifier (TRN-03) Check

• Specify Claim Status Code To Process

• Specify HIPAA Transaction File Input/Output Directories

• Specify Posting Codes By Guarantor

• Specify Posting Codes by Guarantor Override

• Support MSO Other Healthcare Coverage

• Use Specified 835 Directory For File Load

► See Also

• 835 Payment/Adjustment Error Report
• 835 Health Care Claim Payment/ Advice Automation
• How to Test an 835 in myAvatar Cal-PM