Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number

This article instructs Medicare’s claims processing systems maintainers to replace the Health Insurance Claim (HIC) number being sent on the ASC X12 Transaction 835 with the Patient Control Number received on the original claim, whenever the electronic remittance advice (ERA) is reporting the recovery of an overpayment. It has been brought to the attention of CMS that providing the Patient Control Number as received on the original claim rather than the Health Insurance Claim (HIC) number would: • Enhance provider ability to automate payment posting, and • Reduce the need for additional communication (via telephone calls, etc.) that would subsequently reduce the costs for providers as well as Medicare. The ERA will continue to report the HIC number if the Patient Control Number is not available. This applies to the 005010A1 version of ASC X12 Transaction 835 only and does not apply to the Standard Paper Remit or the 004010A1 version of ASC X12 Transaction 835.