decisionhealth Newsletters, Answer Books - 2006 Issue 10 (October)
Medicare_Claims_Processing_Manual / 3923
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Article Overview
This article is a recurring CMS update for Medicare contractors and billing professionals that summarizes changes to remittance advice remark codes and claim adjustment reason codes. It explains the update cycle, applicable transaction types, the role of CMS and X12 code maintenance, and the timing for implementing approved code list changes. The article is relevant to organizations that process Medicare claims, remittance advice, and coordination of benefits transactions.
Why This Topic Matters
Keeping these code sets current is important for accurate claims processing, remittance advice reporting, and coordination of benefits workflows. The article helps readers understand which updates were approved in the referenced period and when they had to be adopted.
Article Sections
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I. General Information
Background on the recurring update, the CMS and X12 code maintenance process, and the transaction types affected by the notice.
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X12N 835 Health Care Remittance Advice Remark Codes
Overview of the remittance advice remark code set, how updates are maintained, and the period covered by the listed changes.
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X12 N 835 Health Care Claim Adjustment Reason Codes
Overview of the claim adjustment reason code set, how changes are approved and posted, and the period covered by the listed changes.
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II. Business Requirements
Administrative requirements and implementation-related instructions associated with the recurring update.
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III. Supporting Information and Possible Design Considerations
Supplemental implementation notes, interfaces, dependencies, testing considerations, and related operational details.
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IV. Schedule, Contacts, and Funding
Effective and implementation dates, contact information, and budget-related statements for the update.
What You Will Learn
- What the recurring update covers and why CMS issues it
- Which claim and remittance transaction types are affected
- How the remark and reason code sets are maintained and updated
- The implementation timeframe associated with the update
- What operational areas Medicare contractors were expected to review
Who Should Read This
- Medicare contractors
- Medical billing staff
- Revenue cycle professionals
- Claims processing teams
- EDI and remittance advice teams
Codes Discussed
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