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Back   Code Value Usage in Health Care Claim Payments and Subsequent Claims (X317)

Purpose

The purpose of this technical report is to present code usage rules for three code sets used in the Health Care Claim Payment/Advice (835). These code sets are:

  • Claim Adjustment Group Codes, published in ASC X12 Health Care Claim Payment/Advice (835) Technical Report Type 3 (005010X221 and errata 005010X221A1)
  • Claim Adjustment Reason Codes (CARCs), available at www.wpc-edi.com
  • Remittance Advice Remark Codes (RARCs), available at www.wpc-edi.com

The TR2 was developed to foster standard code use by presenting the valid combinations of these code sets. These usage rules may be applied to 005010 and 006020 versions of the 835 TR3 but are not mandated for use at this time.

Additional Information

Registered 2/1/2014 Published 10/21/2014
Transaction Set ID 835/837 Standard Version
ASC X12 DM# A12013 Owning Group X12N/TGB/WG3