May/June 2007

Claim adjustment reason code definitions enhanced

On March 26, 2007, Blue Cross and Blue Shield of Florida (BCBSF) added new remark codes to the 835 Electronic Remittance Advice as required by HIPAA-AS. Claim adjustment reason codes are specifically mandated by HIPAA-AS and are not subject to change by BCBSF.  

The new HIPAA-AS requirement effective April 1, 2007, specifies that the 835 Electronic Remittance Advice include at least one remark code in addition to generic claim adjustment reason codes. Examples of generic claim adjustment reason codes that must be accompanied by remark codes include:

16  

Claim/service lacks information, which is needed for adjudication

17

Payment adjusted because requested information was not provided or was insufficient/incomplete

96

Non-covered charge(s)

125        

Payment adjusted due to a submission/billing error(s)

To obtain the most recent and complete list of the claim adjustment reason codes (CARC) and the remittance advice remark codes (RARC), visit the Washington Publishing website at http://www.wpc-edi.com/products/codelists/alertservice.

We are working on several enhancements to the 835 Electronic Remittance Advice in 2007. Look for updates in BlueLine and on our website at www.bcbsfl.com.

For questions about this change, call the Provider Contact Center at (800) 727-2227 or contact your physician/provider relations specialist.