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Back  RFI # 2042: Service-level remarks on 837

Formal vs. Informal Help Informal Formal

Submitter

James Habermann

Description

835 payments can contain remark codes in the MIA/MOA segments if the remark applies to the entire claim or the LQ segment if the remark applies to a specific service line. Subsequent 837 claims should contain the adjustment and remark information received on the 835. Payors can require remark codes on secondary claims in certain cases (e.g. CARC 16). Without the remark codes the secondary claim could be denied. When the remark applies to the entire claim, the 837 allows these codes to be reported in the MIA/MOA segments. However, there does not appear to be a location on the 837 to report service line remark codes. Since the codes do not apply to the entire claim, it does not seem appropriate to report them at the claim level (i.e. MIA/MOA). What is the recommendation for these cases?

Submitter Assigned Keywords

LQ 837

Response

As noted, the 837I 2430 loop, which is where service specific other payer adjudication information is reported, doesn't support reporting of any Remittance Advice Remark Codes (RARC) from the 835. That issue has been resolved for future guides. However, there is no solution available for reporting RARC(s) within the service detail under guide 005010X223A2.

Recommendation

While the MIA and MOA segments only support five RARCs from the 835 and are claim specific, we recommend that claim submitters report any service specific RARC codes in the appropriate (MIA or MOA) segment when not all five locations are already populated by claim level RARCs. When more than a total of five RARCs were present on the 835, the submitter of the secondary 837 should use their best judgement to prioritize which RARCs will be most valuable to the destination payer and report the top five.
Submission 4/29/2015
Status Date 6/5/2015
Status F - Final
Primary References
Document 005010X223
Section2320-MIA
Loop2320
External Code List411 Remittance Advice Remark C