Falls Church, VA, July 12, 2011 – Accredited Standards Committee X12 (ASC X12) announced today that the ASC X12 Type 2 Technical Report Health Care Claim Payment/Advice Code Usage Rules (Codes TR2) is available for industry review. This technical report contains usage rules for all Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC), and Claim Adjustment Group Codes as developed by an X12N Rules Committee, operating within the Insurance Subcommittee (ASC X12N) of ASC X12. The committee and the associated TR2 document were created with the intention of increasing consistent usage of these codes in the health care industry.

This draft technical report defines usage rules for the Health Care Claim Payment/Advice Codes specifically related to the Group Codes (available in the ASC X12 Technical Report Type 3 005010X221 with Errata), CARC, and RARC. The CARC and RARC code sets are both available at www.wpc-edi.com/codesM. Once approved, these usage rules will be revised as necessary when subsequent versions of the 835 TR3 are published.

ASC X12 believes there is a great amount of variability in the mapping and combinations of codes used in the industry today. This variability results in different interpretations by the providers for each payer. This TR2 defines CARC/RARC combinations which will provide a concrete and predictable message, allowing the providers to set up rules to automate actions based upon the combinations of codes. Consistent use of these codes as defined in this TR2 will result in significant administrative simplification in the health care industry.

“Recognizing the health care industry’s need for more consistency in the assignment of codes in the ASC X12 Health Care Claim Payment/Advice (835) and the Health Care Claim (837) transactions, ASC X12 initiated and hosted a joint work effort that included ASC X12 members, representatives from the Claim Adjustment Status Code Maintenance Committee and the Remittance Remark Advice Code Maintenance Committee and maintainers of proprietary mapping documents. This robust group of industry representatives has defined detailed and explicit instructions that, once finalized and implemented, will bring much needed consistency to these mandated electronic exchanges,” said Cathy Sheppard, ASC X12 Chair.

The public review period will commence July 11, 2011 and will close on August 12, 2011 at 5:00 PM eastern time.

The X12N Rules Committee will consider all comments submitted during the public review period. Official responses will be posted to the on-line conference at least 15 days prior to the corresponding Informational Forum. The posted response is not necessarily the final determination. Additional discussion in the Informational Forum may result in the X12N Rules Committee approving a modification to the posted response. Such modifications are not posted to the on-line conference.

This is the only public review period prior to publication by ASC X12. For a complete understanding of changes being suggested and/or made to the technical report, reviewers should monitor the on-line conference during the public review period and consider all developer responses prior to the Informational Forum.

About ASC X12
ASC X12, chartered by the American National Standards Institute more than 30 years ago, develops and maintains EDI and CICA standards along with XML schemas which drive business processes globally. The diverse membership of ASC X12 includes technologists and business process experts, encompassing health care, insurance, transportation, finance, government, supply chain and other industries. For additional information, visit www.x12.org or e-mail: chair@x12.org.