Important Medicare Part B New Jersey News

Remittance Advice Remark Code and Claim Adjustment Reason Code Update

Provider Types Affected
All providers

Provider Action Needed

Impact to You
The June 2004 updates have been posted for the X12N 835 Health Care Remittance Advice Remark

Codes and the X12 N 835 Health Care Claim Adjustment Reason Codes.

What You Need to Know
The most current and complete list will be found online at: http://www.wpc-edi.com/codes/Codes.asp .

Please note that in case of a discrepancy, the code text included on the Washington Publishing Company (WPC) Web site will supersede any corresponding text in a CR.

In addition, with respect to Health Care Claim Adjustment Reason Codes, few temporary reason codes (D16-D20) were added for the cases where commercial payers do not make use of the available remark codes when the reason code used is too generic to help providers decide on the follow-up action. Medicare will not use these new temporary reason codes but rather will continue the current use of the combination of reason and appropriate remark codes.

What You Need to Do
The above noted codes are updated three times a year. Please advise billing staff to stay current with the latest approved and valid codes, in accordance with effective and implementation dates, to ensure accurate Medicare claims processing.

Background
The Remittance Advice Remark Code list is one of the code lists mentioned in the ASC X12 transaction 835 (Health Care Claim Payment/Advice) version 4010A1 Implementation Guide (IG). This list is maintained by the Centers for Medicare & Medicaid Services (CMS) and is updated three times a year.

The complete list of current codes is available online at the WPC Web site: http://www.wpc-edi.com/codes/Codes.asp .

The Health Care Claim Adjustment Codes are maintained by the Claim Adjustment Reason Code and Status Code Maintenance Committee. The Committee meets at the beginning of each X12 trimester meeting (February, June, and October) and decides on any additions, modifications, or retirement of reason codes. The updated list is posted three times a year, and the complete list of current codes is available online at the WPC Web site: http://www.wpc-edi.com/codes/Codes.asp .

Additional Information
The most recent changes approved for the Remittance Advice Remark Codes and the Claim Adjustment Reason Codes can be found in the official instruction issued to your carrier or fiscal intermediary, including Durable Medical Equipment Regional Carriers (DMERCs). That official instruction is found in CR 3466, which is available at: http://www.cms.hhs.gov/Transmittals/ .

Once at that page, scroll down the CR NUM column on the right to find the link for CR 3466. Click on the link to open and view the file for the CR.

The CR attachments also include information on the decision making process that results in updates to the X12N 835 Health Care Remittance Advice Remark Codes and the X12 N 835 Health Care Claim Adjustment Reason Codes. It also includes a table of changes; however, please note that the most current and complete list is online at the WPC Web site. This CR includes changes made only from March through June of 2004.

If you have questions regarding this issue, you may also contact your carrier or fiscal intermediary at their toll-free number at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf.

Disclaimer
Medlearn Matters articles are prepared as a service to the public and are not intended to grant rights or impose obligations. Medlearn Matters articles may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.

For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/MedlearnMattersArticles/.

Pub. 100-4, Transmittal # 313, CR # 3466
Medlearn Matters Number: MM3466

Effective Date: January 1, 2005
Implementation Date: January 3, 2005