I might also add to that. The LQ segment also allows a qualifier of RX for NCPDP reject / adjustment codes. These codes are more specific for drug related responses. Generally, NCPDP is recommending that they be used in conjunction with Adjustment reason codes 16, 96 and 125.
Ken Steen ----- Original Message ----- From: "Doug Webb" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Cc: <[EMAIL PROTECTED]> Sent: Monday, September 23, 2002 1:45 PM Subject: Re: 835 codes The remark codes are to transmit information that could not be communicated wholly in the Adjustment Reason codes. They are to be used when the situation described by the text associated with the code exists. If none of the conditions described in the Remark code list exist, you do not have to issue any remarks. If the Remark text adds nothing to what the Adjustment Reason already said, it need not be sent. For Example, you would send a M81 code to communicate the sentence "We do not pay for this as the patient has no legal obligation to pay for this.". The Reason code could something such as 96 - "Non-covered Charge(s)". Together they make up the reason that nothing was paid, with the Remark code supplying detail for the Reason code. Douglas M. Webb Computer System Engineer Little Company of Mary Hospital & Health Care Centers [EMAIL PROTECTED] "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately and delete the material from any computer. Do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you." ----- Original Message ----- From: "Fleming, Cindy R" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Cc: <[EMAIL PROTECTED]> Sent: Monday, September 23, 2002 01:34 PM Subject: RE: 835 codes > Jan, > Thank you for responding. Could you please clarify for me the 'situations' > where the remark codes are required? > > Thanks, > Cindy > > -----Original Message----- > From: Jan Root [mailto:[EMAIL PROTECTED]] > Sent: Monday, September 23, 2002 10:39 AM > To: [EMAIL PROTECTED] > Subject: Re: 835 codes > > Actually both are situational. The CAS segments are both situational (use > them > when you made an adjustment). The Remarks segments/elements (in the MIA, > MOA, > etc) are also situational. I think payers are required be able to send > information to explain adjustments. The business goal is to reduce provider > phone calls about payments! > > Jan Root > UHIN Standards Managers > > [EMAIL PROTECTED] wrote: > > > According to the Implementation Guide, the Adjustment Reason Code is > > required and the Remark Code is optional. Let me know if anyone has other > > information. > > > > > -----Original Message----- > > > From: Fleming, Cindy R [SMTP:[EMAIL PROTECTED]] > > > Sent: Friday, September 20, 2002 4:55 PM > > > To: '[EMAIL PROTECTED]' > > > Subject: 835 codes > > > > > > The 835 transactions contains both a claims adjustment reason code and a > > > remittiance remark code. Are we required to provide both? > > > > > > > > > Thanks for any information you may be able to share. > > > Cindy Fleming > > > > > > > > > > > > ********************************************************************** > > > To be removed from this list, send a message to: [EMAIL PROTECTED] > > > Please note that it may take up to 72 hours to process your request. > > > > > > ====================================================== > > > > > > The WEDI SNIP listserv to which you are subscribed is not moderated. > The > > > discussions on this listserv therefore represent the views of the > > > individual > > > participants, and do not necessarily represent the views of the WEDI > Board > > > of > > > Directors nor WEDI SNIP. 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