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Additional Service Determination Methods - Registry Setting

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

This registry setting enables you to enhance the determination logic by making the search more precise.

When searching for services to post a payment/adjustment, the 835 compares the procedure code and modifiers received in the SVC segment against the procedure code and modifiers in the system. This is the default behavior and the behavior when 'N' is selected for this registry setting.

'Y' enables the Additional Service Determination Methods field in the 835 Health Care Claim Payment/Advice form and the 835 section of the Guarantors/Payors form.

This field specifies the following additional determination methods when searching for services to post a payment or adjustment:

  • Compare Line Item Charge Amount (2110-SVC-02) against the service charge amount in the system: 
    Selecting this value enables the 835 to also compare the line item charge amount received in the SVC segment against the service charge amount in the system.  Note: When this value is selected, payment/adjustments might not be posted for services that were consolidated or rolled-up during bill generation.

  • Compare Patient Control Number (2100-CLP-01) against the Patient Account Number (2300-CLM-01) submitted on the 837: 
    Selecting this value enables the 835 to also compare the patient control number received in the CLP segmentagainst the patient control number submitted in the CLM segment of the corresponding 837.  If no match was found, all payments for the CLP segment will appear in the Un-Postable Payments report. 

  • Use Provider Control Number (REF*6R) to determine the Avatar claim number. 
    Selecting this value enables the 835 to process a claim against the claim number found in the service identification REF segment if the claim number found in the service identification REF segment is different than the claim number found in the Patient Control Number (2100-CLP-01).  As long as the claim number found in the service identification REF segment is valid within the system and is different from what was sent in the Patient Control Number (2100-CLP-01), it will be the claim number that is used.  This selection is only available when "Load File" is selected for 'Options'. 

  • Use Health Care Remark Code (2110-LQ) as Denial Reason Code to file Claim Follow-Up for denied services. 
    Selecting this value enables the 835 to use Health Care remark Code (2110-LQ) as the 835 Denial Reason Code instead of the Adjustment Reason Code (CAS) when filing Claim Follow-Up for denied services. If a remark code is not found then the adjustment reason code (default behavior) will be used as the denial reason code. 

  • Skip Line Item Provider Payment Amount (2110-SVC-03) When Distributing Claim Level Adjustments (2100-CAS) Across All Services. 
    Selecting this value enables the 835 to ignore any Line Item Provider Payment Amount (2110-SVC-03) when distributing claim level adjustments (2100-CAS) across all services. This value will not have any effect if there are any service level adjustments (2110-CAS) or there are no claim level adjustments (2100-CAS) for the claim being processed.  This selection is only available when the registry setting 'Distribute Claim Level Adjustments (2100-CAS) Across All Services' is set to "YS".

'N' compares the procedure code and modifiers received in the SVC segment against the procedure code and modifiers in Avatar.