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How to create an 835 with a $0 payment (or denial)

Page history last edited by Kepa Zubeldia 2 yrs ago

I solicited feedback from Bob Poiesz, the "father of the 835", on this issue. It turns out there are a couple of official Implementation Guide Interpretations on this topic already posted to the HIR web site by X12. Bob has included them in his response below. Also, at the very bottom, see the feedback from the issue submitter, Broadspire, on this topic.

From: Bob Poiesz <bobp@wpc-edi.com>

Sent: Friday, December 07, 2007 12:11 PM

To: Zubeldia, Kepa

Subject: RE: Need help with 835 for Texas WC

Kepa,

I’ll try to help.

The note on BPR01 code H includes “Usually this code is used to pass predetermination of benefits information from a payer to a provider.” “Usually” does not indicate an exclusive usage. Code H can be used in other business situations, as long as there is no real transfer of funds taking place. In fact, H is the only valid BPR01 value when BPR04 is “NON”, indicating no payment. This is supported by HIPAA IG Interpretation Portal responses to questions 352 and 444.

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HIR 352

Question:

If the transaction payment amount in element BPR02 is $0, should the qualifier in BPR01 be 'I' for remittance info only or 'H' for notification only? 'H' suggests there is no reference to payment but that did not seem to fit because we wanted to be clear that the final payment for this transaction is $0. Our 835 carries remittance info without actually moving money so ‘I’ appears to fit better but this creates a problem with element BPR04. Qualifier ‘NON’ is used when no dollars are to be moved but the IG states this is used when BPR01 is ‘H’. If we can’t use ‘NON’ with ‘I’ then the only alternative is ‘CHK’ but no check is written because the payment is $0. Can ‘CHK’ be used when the payment is $0 and no check is written? If the payment is $0, is I/CHK the best fit or should we go with H/NON? Can ‘NON’ be used when 'I' is used?

Response:

This issue is explicitly addressed in guide 004010X092. At the BPR level, "payment" refers to the actual movement of funds, not whether any specific claim is being paid.

The BPR01 code "I" note reads "Use this code to indicate to the payee that the remittance detail is moving separately from the payment." The Code "H" note reads "Use this code to pass information only without any reference to payment." The note BPR04 code "NON" note reads "Use this code when the Transaction Handling Code (BPR01) is H, indicating that this is information only and no dollars are to be moved." Since no money is moving, the 835 isn't making a payment and there can be no reference to a payment. The required codes are BPR01=H and BPR04=NON.

CHK can't be used when no check is written. That contradicts the business situation. A combination of BPR01=I and BPR04=NON isn't appropriate since one code means the remittance and money are moving separately and the other means there is no money, which is a contradiction.

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HIR # 444

Question:

When BPR01 equals qualifier code 'I', can the provider populate BPR04 with payment method code 'NON'? Below is an example:

BPR*I*0*C*NON******1161105741******20060827~

The payer is stating that there is no where in the HIPAA IG that indicates that 'H" is required when BPR04 is 'NON'.

Response:

The note for BPR04 is NON states: "Use this code when the Transaction Handling Code (BPR01) is H, indicating that this is information only

and no dollars are to be moved." Therefore the only time NON can be used is when BPR01 is H. No other BPR01 qualifier is valid.

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Will that do the job?

Bob