More Information

Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message as shown in the Remittance Advice Remark Code List.

Answers to the following questions are available by clicking the question

• How do I request a change?
• Can I be notified about list changes?
• Who maintains the list?
• What is the maintenance process?
• Are there guidelines for new codes?
• Where are they used?
• Isn't this a Medicare-Only List?
• When are they effective?
• How do I monitor my change request?
• Are there other FAQs?

How do I request a change?

There are three types of change requests

Type 1
A request for a new Informational Remittance Advice Remark Code (a message that does not explain a change between the billed amount and the payment).
- Instructions for submitting an Informationl Remittance Advice Remark Code:
  Review the existing Remittance Advice Remark Codes to verify that a code doesn't already exist with the same or similar message.
  
  Complete and submit the form using the "Change Request Form" link above. Enter the message text for the proposed Remittance Advice Remark Code in the description field and a business justification explaining why the remark is needed in the explanation field. The business justification must explain the scenario in which the requested Remittance Advice Remark Code would be sent in an 835 or other Remittance document.
Type 2
A request for a new Remittance Advice Remark Code to Supplement a Claim Adjustment Reason Code (a message that further explains a change between the billed amount and the payment).
- Instructions for submitting a Supplemental Remittance Advice Remark Code:
  Review the Claim Adjustment Reason Codes to verify that a code doesn't exist with the same or similar message.
  
  Review the Claim Adjustment Reason Codes to verify that an appropriate Claim Adjustment Reason Code exists to use as the primary explanation for the adjustment.
  
  Review the Remittance Advice Remark Codes to verify that a code doesn't exist with the same or similar message.
  
  Complete and submit the form using the "Change Request Form" link above. Enter the message text for the proposed Remittance Advice Remark Code in the description field and a business justification explaining why the remark is needed in the explanation field. The business justification must explain the scenario in which the requested Remittance Advice Remark Code would be sent in an 835 or other Remittance document.
  
  Enter the Claim Adjustment Reason Code to be used as the primary explanation
Type 3
A request to Modify the text of an existing Remittance Advice Remark Code.
- Instructions for submitting a Modification to an existing Remittance Advice Remark Code:
  Complete and submit the form using the "Change Request Form" link above.
  
  Enter the Remittance Advice Remark Code in the Existing Remark Code field. Enter the proposed new message text in the description field and a business justification explaining why the change is needed in the explanation field.

Can I be notified about list changes?

Yes, the Remittance Advice Remark Code Project is pleased to offer broadcast announcements that will help ensure that information is available in a timely and convenient manner.

Click Here to sign up for a broadcast service that will notify you of two events in the REMARK maintenance process.

Announcements will be sent when a new version of the list is published, and
When decisions about pending requests are posted to the Remittance Advice Remark Code List On-line Conference for public review.

Who maintains the list?

The Centers for Medicare and Medicaid Services (CMS) by the Remittance Remark Advice Code Maintenance Committee whose members represent various components from CMS.

What is the maintenance process?

Each change request follows a four step process:

A maintenance request is created.
The Remittance Advice Remark Code Committee reviews the submitted requests and notifies the requester of the committee's decision.
The Remittance Advice Remark Code Committee prepares an updated list with all maintenance items processed since the last publication date.
An updated Remittance Advice Remark Code List is published tri-annually at the end of March, July, and November.

Are there guidelines for new codes?

Yes, the following are guidelines for the creation of new Remittance Advice Remark Codes:

The text of new Remittance Advice Remark Codes will be generic enough for general use by multiple payers, for multiple benefit plans, or in multiple situations. Approval of Remittance Advice Remark Codes related to specific procedures, specific time requirements or specific data elements will be severely restricted.
The text of all new Remittance Advice Remark Codes will be broken down into their simplest components for maximum industry use. Multiple Remittance Advice Remark Codes may be transmitted to communicate explicit messages.
The text of all new Remittance Advice Remark Codes will support compliant electronic claims. It is expected that non-compliant claims will be identified in a front-end process or in an application process and reported in an appropriate response transaction rather than in the 835 remittance advice.

Where are they used?

004010X091 - Health Care Claim Payment/Advice (835)
At either the claim or service line level as appropriate for the specific situation in MIA05, 20, 21, 22, & 23; MOA03, 04, 05, 06, & 07; and LQ02. Remittance Advice Remark Codes at the claim level convey information about claim level adjustments or about the overall processing of the claim. Remittance Advice Remark Codes at the line level convey information about adjustments for the specific service line or about the processing of those services. Remittance Advice Remark Codes will seldom be used unless there is an adjustment to report.

Isn't this a Medicare-Only List?

Although the Remittance Advice Remark Code List was once a proprietary list created and supported for Medicare use only, it is now an industry code list. Use of the Remittance Advice Remark Code List is mandated in the HIPAA Rules. Older codes included in the list may be payer-specific, but the text of all new codes will be generic enough for general use by many payers.