We have a payer that is using duplicate TRN02 values for the circumstance of reversals.
The first 835 they sent has a TRN02 value of "00004932" for multiple claims, for multiple patients. The second 835 they sent uses the same TRN02 value and BPR16 as the original 835, but only reverses one of the claims form the original 835.
The payer states the spec indicates this is required to link the reversal with the previous 835, but I couldn't find anything that says that. I'd like a determination on the re-use of the TRN02 value in, but not limited to, this situation.
his issue is explicitly addressed in the 005010X221A1 TR3. The TRN02 semantic and element notes read as follows:
“SEMANTIC: TRN02 provides unique identification for the transaction.”
“This number must be unique within the sender/receiver relationship. The number is assigned by the sender. If payment is made by check, this must be the check number. If payment is made by EFT, this must be the EFT reference number. If this is a non-payment 835, this must be a unique remittance advice identification number.”
The note requirement explicitly states that the TRN02 must be unique for each transaction exchanged between a given sender/receiver relationship.
There is no requirement in Section 1.10.2.8 - Reversals and Corrections, that the reversal claim must be tied to the original payment 835 via the TRN02 or BPR16. If the reversal is a non-payment 835 (BPR04=NON), both BPR16 and TRN02 have specific data requirements for non-payment 835 reporting that makes them unique. The CLP07 is used to tie original claim payment to the reversal. Section 1.10.2.8 Reversals and Corrections, reads in part:
“The CLP07 Payer Claim Control Number in the reversal must be identical to the CLP07 value in the original claim payment.”
The second 835 transaction will not balance based on the description in the RFI. All transactions must balance at the service, claim and transaction level.