TO:  All Providers

 

RE:   Upcoming Changes to the 835 Electronic
Remittance Advice

 

The Medicaid Agency is modifying
the way claims are reported on the 835 Electronic Remittance Advice. These
changes are to ensure compliance with the HIPAA X12 Standard for Claim Level
balancing on the 835 transaction.

 

In order to assess the impact of
these changes we request taking the following steps:

 

  1. Review the following
    summary on the upcoming changes:

The
claim types listed below will now be reported at the header level (Claim
Payment Information Loop 2100), with no detail level (Service Payment
Information Loop 2110) data returned. Payments and adjustments will now be
reported at the header level (Claim Payment Information Loop 2100).

 

·        
Inpatient

·        
Outpatient Crossover

·        
Compound Pharmacy

 

For all claim types, the Allowed
Amount (AMT*B6) will continue to be reported in the 835 but for informational
purposes only and should not be used when balancing claim payments and
adjustments.

 

For all other claim types, the
structure of the claims will NOT
change, but users may see some changes in adjustment amounts and CARC / RARC
codes returned, to more accurately reflect claims pricing and ensure claim
level balancing.

 

  1. Complete the below survey
    so we can better understand the impact of these changes.
    We will use the survey results to help plan
    the testing and implementation timelines for the above changes.

 

Note: If you are a provider who
utilizes a third-party software vendor and/or clearinghouse to process Alabama
Medicaid 835s, please communicate with them to assess the impact of these
changes and complete the survey at:  https://www.surveymonkey.com/r/LJKD3RP
.

 

  1. Participate in
    835 Electronic Remittance Advice Testing 

A User Acceptance testing period will be provided. The
Medicaid Agency requests that those who would like to participate in testing
the modifications to the 835 transaction submit their contact information on
the parties responsible for testing and implementation using the survey link
above.

We currently
anticipate that User Acceptance testing will begin in mid-December through
January. However, we will use input received in the survey to decide on time frames
for the User Acceptance Test period and Production Implementation timeline.
Additional communications regarding specific dates and requirements of testing
will be provided at a later date.

 

Providers with questions
concerning the upcoming changes can submit them via the following email
address: interChange_Testing@dxc.com

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Author: Editor
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