Skip to main content

835 Section - PM

  1. Last updated
  2. Save as PDF

Define codes and standards for an 835 transaction.

Note: Any selections in the 835 Health Care Claim Payment/Advice form will override the default settings entered on this form.

  1. In the Automated 835 Actions field, select:
  • Do Not Include to prevent the system from loading, compiling, or posting any 835 files automatically. This selection does not enable the Load File, Compile File, and Post File fields.
  • Load File to load the file only for the guarantor.
  • Compile File to load and compile the file for the guarantor.
  • Post File to load, compile and post the files for the guarantor.

  1. In the Process Transaction Handling Code(s) field, select the appropriate codes. The selections in this field are populated by the values from the same field in the 835 Health Care Claim Payment/Advice form.

  2. In the Payment Posting Code field, select the default Posting Code.

  3. In the Payment Reversal Code field, select the default Reversal Code.

  4. In the Allow Overage Adjustments to be Posted? field, select whether or not overage adjustments compiled from the 835 file are eligible to be posted for this guarantor in 835 Health Care Claim Payment/Advice.

  5. Allow posting of crossover payment/adjustment prior to payment/adjustment from the original guarantor

  6. Allow Adjustment Reversals controls whether the system will automatically back out all automatic contractual adjustments for a service when an 835 is returned. If this is set to Yes for the payor and an 835 is received for the service, if there was an automatic contractual adjustment taken against a service, the system will automatically reverse out that contractual adjustment. The system will not automatically reverse out contractual adjustments that were entered manually. Then the system applies the adjudication from the 835 (payments, adjustments, transfers). This functionality is supported by the 'Contractual Allowance by Liability Distribution' process and the 'Contractual Allowance by Batch' process.

If the guarantor is configured to use 'Contractual Allowance by Batch', when an 835 comes back and the automatic contractual adjustment is automatically reversed and you are presented with a scenario where you have to rebill the same guarantor (for example: the service was denied due to an invalid authorization number), the system will reapply the contractual adjustments when the service is rebilled. The contractual adjustment will reapply when the process is run from the following forms: Contractual Allowance (Outpatient), Contractual Allowance (Inpatient), or Quick Billing (with the selection of the 'Post Contractual Adjustment' option).

► Registry Settings
► SQL Table
  • SYSTEM.billing_guar_table_835