835 Health Care Claim Payment/Advice

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

• 835 outbound files detail remittance information for services in the 837 file.
• In addition to information in the claim, information is retrieved from the following forms:

  • Contracting Provider 835 Defaults

  • Contracting Provider/Funding Source 835 Defaults

• The Sort Final option becomes available for selection if the Provider Adjustment (PLB) registry setting is set to 'YFB'. However, this was existing functionality used to calculate PLB-04 and BPR02 segments on an 835 compile. Once the 835 has been sorted using the Sort Final option, you cannot compile an 835 for that EOB again. The PLB fields have moved to the Create EOB form.

1. Go to: Avatar MSO > Claims Processing > 835 Health Care Claim Payment/Advice

2. In the Options field select:

• Sort File - compile an 835 outbound file.

• Run Report - generate the 835 Health Care Claim Payment/Advice report, which details information in the 835 file.
  The report contains two sub-reports:
  835 Health Care Claim Payment/Advice Report
  835 Health Care Claim Payment/Advice Errors Report

• Dump File - generate a report of the compiled file.

• Delete File - delete a compiled file.
  Select Delete to remove the file from Avatar MSO.
  Deleting a file removes the file from myAvatar . Claims in the file will have to be rebilled.
  Deleting a billing file that has been claimed, but that has not been created on the server will remove the file and its information.

• Create File On Server - to create the 835 file on the facility's server.
  The file location is set up in the Set System Defaults form.

2. The Contracting Provider field displays contracting providers who EOBs have been created.

3. In the Exclude EOB(s) On Previous 835 field:

   • Select Yes to display EOBs are not included in a previous 835 Health Care Claim Payment/Advice file.

   • Select No to include all EOBs that have been submitted for the provider.

4. In the Segregate 835 File To field, select whether the EOBs to be available for selection for 835 sorting under the Select EOB field will include only Approved EOBs or only Denied EOBs. If no value is selected, the available EOBs will include both.

5. In the EOB Date field, enter the date to associate with the EOBs included in the 835 Health Care Claim Payment/Advice files.

6. In the Select EOB(s) field, choose the EOBs to include in the 835 file.

7. In the Select File field, select the 835 file.
   This field populates when an 835 file is created (Sort File selected in the Options field).

8. Click Process.

► Registry Settings

• Enable HIPAA Version 5010
• Include Remark Codes (2110-LQ)
• Provider Adjustment (PLB)
• Specify Adjustment (2110-CAS) Logic