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Minnesota AUC Administrative Simplification
 

Explanation of Benefits (EOB)/ Remittance Advice
Technical Advisory Group


Meeting Information

Policies

SBAR and work request forms

Co-chairs

 • Pete Anderson   pete_anderson@uhc.com  860-702-6670

 • Lisa Wichterman  lisa.wichterman@state.mn.us  651-284-5173

This TAG is focused on creating and maintaining a common companion guide for the 835/Remittance Advice. Previous work included developing standards for paper member EOBs.

Charge and mission statement of work

Create and maintain a common companion guide and best practices for the 835 transaction, covering topics such as:

  1. Usage of situational data elements
  2. Usage of CAS Segment including business uses for the Group Codes, Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC)
  3. Usage of the PLB segment including business uses of the PLB codes
  4. Recommendations for:
    • reversals
    • reporting primary payer information on secondary claims
    • overall balancing rules
  5. Develop and propose best practices
  6. Monitor and contribute to national level standards setting activities

Accomplishments:

  • Created uniform paper member EOB and provider Remittance guides.
  • Created 4010A1 Companion Guide and best practices.
  • Reviewed 5010 HIPAA Implementation Guide and document changes needed in the companion guide.

Work Plan:

  1. Ongoing review of External Codes Related to the 835 Transaction (Group Code, CARC and RARC) to determine appropriate business scenarios and recommended usage.
  2. Propose new codes to codes maintenance committees as needed.
  3. Create front matter to address other Implementation Guide issues that need clarification.
  4. Track developments related to HPID/OEID (including any errata to TR3s).

Work product to be developed by TAG
Annual update to common companion guide and any best practices.

Work groups: N/A

Activation or re-activation date: 7/12/2007

Inactivation date: N/A

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