Do payers have to process correction claims (Frequency "7") in a single 835 remittance or can they split it into two separate remittance files? If they can split, it does this allow them to recover the original claim and monies and then deny the new claim?
Payer pays an inpatient claim $10,000 and then the hospital submits a replacement claim as an adjustment to correct the diagnosis coding on the original claim thinking the new payment should be worth $12,000. Can the payer recover the $10,000 and then weeks later re-adjudicate the claim with the new coding denying it for payment because of a coding edit? Must both halves of an adjustment come in a single 835? Can an adjustment allow them to deny the overall claim and recover all monies previously paid.
The 835 5010 TR3 guide does not explicitly discuss sending a reversal and correction in a single 835.
As it relates to when money can or cannot be recovered, that is a business decision between the payer and the payee. Refer to 1.10.2.17 Claim overpayment and Recovery section of the guide for information on how to relay information in the 835 ERA based on those business decisions.
From an industry perspective it is recommended as a best practice to send a reversal and correction in a single 835. When time elapses between a reversal and correction, it may generate abrasion and unnecessary calls from the provider to the payer.