Implementation Manual for the Healthcare Claim Payment Advice: Guidelines For...
McGraw-Hill School Education Group, 1995 - Social Science - 162 pages
This edition is a guide to using the 835 healthcare claim payment/advice standard. Developed by committees of the American National Standards Institute (ANSI) to help automate remittance processing, the 835 can be used to electronically receive and process payments and remittance information as well as to reduce administrative costs and human error. This manual takes readers through the process of effectively receiving remittance information and allows the user to automate: mail and check deposits; medicare, medicaid and commercial payor payment logs; reconciliation of bank deposits with remittance detail; and reconciliation of submitted charges with actual payment.
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Technical Specifications for Detail Area Data Segments and Elements
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127 Description 127 Reference Number 782 Description 782 Monetary Amount Account Number Adjustment Reason Code Amount Data Element amount of adjustment amount see Semantic ANSI ASC X12 automated clearing house Characteristics Reference Designator Claim Adjustment Reason Claim Payment Code Data Element Code Definition Code identifying Communication Number control number Data Element Characteristics Data Element Values data segment Designator Reference Number diagnosis-related group electronic electronic data interchange Element Characteristics Reference format further definition identification number Maximum Name Type Medicaid Mandate—Category Medicare Monetary Amount Data Monetary Amount Optional National Drug Code note 1 identifies Notes for further number as defined Number Data Element number or identification Number Requirement Designator Optional R 1/15 particular Transaction Set payer Provider Number Qualifier Data Element Quantity Data Element Reference Designator Reference Reference Number Data Reference Number Qualifier Reference Number Requirement remittance information Requirement Designator Minimum Semantic Notes service being adjusted submitted charges value of quantity