Standardizing the standard – Operating Rules for code usage in Remittance Advice

CR 8182 instructs Medicare contractors to implement the Phase III Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Electronic Funds Transfer (EFT) & Electronic Remittance Advice (ERA) by January 1, 2014. The same rules will also apply to Standard Paper Remittance (SPR), as Medicare reports the same standard codes in both electronic and paper formats of remittance advice.

The ERA/EFT Operating Rules mandate consistent and uniform use of Remittance Advice (RA) codes (Group Codes, Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC)) to mitigate confusion that may result in:

• Unnecessary manual provider follow-up;

• Faulty electronic secondary billing;

• Inappropriate write-offs of billable charges;

• Incorrect billing of patients for co-pays and deductibles, and/or

• Posting delay.