Remittance Advice Remark Code and Claim Adjustment Reason Code Update
This article updates the Remittance Advice Remark Code and Claim Adjustment Reason Code lists. All new and revised material is effective January 1, 2004.
X12N 835 Health Care Remittance Advice Remark Codes
The Centers for Medicare & Medicaid Services (CMS) is the national maintainer of the remittance advice remark code list that is one of the code lists mentioned in ASC X12 transaction 835 (Health Care Claim Payment/Advice) version 4010A1 Implementation Guide (IG). Under the Health Insurance Portability and Accountability Act (HIPAA), all payers, including Medicare, have to use reason and remark codes approved by X12 recognized maintainers instead of proprietary codes to explain any adjustment in the payment. The CMS receives a significant number of requests for new remark codes and modifications in existing remark codes from non-Medicare entities, and these additions and modifications may not impact Medicare. Traditionally, remark code changes that impact Medicare are requested by Medicare staff in conjunction with a policy change. Contractors are notified of those new/modified codes in the corresponding implementation instructions which implement the policy change, in addition to the regular code update notification. If a modification has been initiated by an entity other than Medicare for a code currently used by Medicare, contractors must use the modified code even though the modification was not initiated by Medicare. If a new code is not initiated by Medicare, contractors do not have to use it unless otherwise instructed by Medicare. Contractors must stop using codes that have been deactivated on or before the effective date specified in the comment section if they are currently being used. The list posted on the two Web sites also have the following codes deactivated without any replacement codes: M16, MA116, and MA94. Research has revealed that these codes are still being used by Medicare contractors, and will be re-activated in the next update. These codes are not included in this document, and contractors do not need to deactivate them.
The complete list of remark codes is available at:
http://www.cms.hhs.gov/providers/edi/hipaadoc.asp
and
http://www.wpc-edi.com/codes
The list is updated 3 times a year - in the months following X12 trimester meetings. The following list summarizes changes made from March 1, 2003 to June 30, 2003.
The Current changes, in a pdf format, can be viewed by clicking this link.*
*To read these documents,
you will need to have an Adobe Reader installed on your system.
You may download a free reader from the Adobe site by clicking here.
Page Last Updated: Tuesday, 26-Feb-2008 14:16:26 CST
