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Formal vs. Informal Help Informal Formal


ben bartek


EDI 835 5010 help - code “CR” will be eliminated from CAS01

Code changes in the ANSI Electronic 835 Remittance Claim Adjustment segment in preparation for ANSI 5010 for managed care claims - The code “CR” will be eliminated from Loops 2100 (Claim Adjustment) and 2110 (Service Adjustment).

So, how does a Payer handle a Correction/Reversal in the new 835?

Does the Payer just replace the “CR” code and use the “OA” (other Adjustment) code and proceed as in the 4010? No real process or functionality difference, just a code deletion?

Thank you,

Ben Bartek


This issue is explicitly addressed in guide 005010X221. Section states on page 30 "Reversing the original claim payment is accomplished with code 22, "reversal of previous payment", Send original Claim Adjustment group codes in CAS01; and appropriate adjustments. All original charge, payment, and adjustment amounts are negated."

As a result, there is a specific process and functionality. The reversal must report each original adjustment with the original Group Code and a negated dollar amount.
Submission 9/2/2010
Status Date 9/27/2010
Status F - Final
Primary References
Document 005010X221
Set ID835W1
External Code ListOD: 835W1_2110_CAS01__ClaimAdj
Code ValueCR