EOB/Remit TAG

AUC EOB/Remit TAG

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

This TAG is focused on creating and maintaining a common companion guide for the 835/Remittance Advice. Previous work included developing standards for paper member EOBs.

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.

Updated Friday, 10-Apr-2020 16:55:38 CDT