Explanation of Benefits (EOB)/Remittance Advice TAG
This TAG is focused on creating and maintaining a common companion guide for the 835/Remittance Advice.
• Pete Anderson firstname.lastname@example.org 860-702-6670
• Lisa Wichterman email@example.com 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:
- Usage of situational data elements
- Usage of CAS Segment – including business uses for the Group Codes, Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC)
- Usage of the PLB segment – including business uses of the PLB codes
- Recommendations for:
- reporting primary payer information on secondary claims
- overall balancing rules
Develop and propose best practices
- Monitor and contribute to national level standards setting activities
- 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.
- Ongoing review of External Codes Related to the 835 Transaction (Group Code, CARC and RARC) to determine appropriate business scenarios and recommended usage.
- Propose new codes to codes maintenance committees as needed.
- Create front matter to address other Implementation Guide issues that need clarification.
- 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