Program_Memos / 2001 / B-01-35

Why This Topic Matters

The memo helps payers and implementers align Medicare remittance advice reporting with HIPAA transaction standards and avoid use of elements that do not apply to Medicare. It also documents how remark codes were organized and updated for the 4010 version, which affects claims editing, remittance formatting, and system maintenance.

Article Sections

1. Overview

   Introduces the HIPAA context for the remittance advice standard and describes the purpose of the Medicare companion document.

2. Table 1 - Header Data

   Covers header-level X12N 835 segments and Medicare-specific reporting notes for payer and payee identification, contact information, and related transaction elements.

3. Table 2 - Detail Data

   Describes detail-level segments for claim, patient, service, adjustment, and remark reporting within the Medicare remittance advice.

4. Table 3 - Summary

   Summarizes provider-level adjustment reporting and the summary segment requirements for Medicare remittance advice transactions.

5. Attachment 2 - Remittance Advice Remark Codes

   Reviews the remark code framework, category groupings, version 4010 changes, and the list of remark code identifiers referenced in the attachment.

6. Requests for Additional Codes

   Provides the process for submitting requests related to remark code maintenance and updates.

7. Attachment 3

   Shows a sample Medicare remittance notice format and layout elements used to present payment information.