AUC EOB/Remit TAG

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This TAG is focused on creating and maintaining a common companion guide for the 835/Remittance Advice.

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:
  • reversals
  • 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).

Annual update to common companion guide and any best practices.