835 Payment with Dollars and Data Separate
This an example of the 835/payment transaction from X12.org:
This scenario depicts the use of the 835 in a managed care environment. The funds are moved separately from the remittance detail. In this scenario, the funds are sent by EFT to the provider’s account and the remittance advice is sent to the provider.
In more details:
- BPR segment: The dollars move from the Hudson River Bank, ABA# 888999777, account number 24681012 to the Amazon Bank, ABA# 111333555, checking account number 144444 using the ACH network. The money moves on March 16, 2019. This information is encoded in the BPR segment.
- The insurance company, Rushmore Life, Federal Tax ID # 935665544, is paying ACME Medical Center, National Provider ID 5544667733 & Federal Tax ID # 777667755, a total of $1100.00. You can find the payment amount in the BPR segment as well.
- The first patient’s name is William Budd, patient number 5554555444 and member ID # 33344555510. Total reported charges are $800.00. Amount paid is $500.00. Patient responsibility is $300.00. This is explained in the first CLP segment.
- The second patient’s name is Susan Settle, patient number 8765432112 and member ID # 44455666610. Total reported charges are $1200.00. Amount paid is $600.00. Patient responsibility is $600.00. This is explained in the second CLP segment.
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