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Back  RFI # 438: proprietary codes

Formal vs. Informal Help Informal Formal

Submitter

Richard Firestone

Description

As a payer we have a provider that is asking us if we can use some of the extra bytes or not used fields in the ERA transaction to put in our proprietary adjustment reasons. If we are allowed to do this where would you suggest that we put our proprietary codes?

Submitter Assigned Keywords

Reason codes ERA proprietary codes

Response

There is no location within the 835 transaction that is able to convey payer's proprietary reject reasons or adjustment codes. Use of proprietary codes is not compliant with the intent of guide. There are a number of locations within the 835 that can be used to convey the same information held within a proprietary code, including but not limited to the LQ, SVC, CLP REF, and NM1 segments. Payers who have successfully implemented the 835 have mapped their proprietary codes to all of the elements that convey information AND have created a cross-walk for their providers so that the providers are better able to map their account receivable systems.

Recommendation

The 835 workgroup has conducted a couple training sessions on how to convey complete information to providers. The presentations are located at www.wpc-edi.com/docman/Itemid,264/. Select the ASC X12N/TG2/WG3 Lunch and Learn Sessions hyperlink. The sessions were held in 2004 and 2005.
Submission 8/1/2006
Status Date 9/8/2006
Status F - Final
Primary References
Document 004010X091A1
Section2.2.4
Page23
Set ID835