The Alabama 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.
UPDATE: These
changes are currently available in our test environment for Provider and Vendor
testing. Testing should be completed by February 16, 2021. The updated
reporting will be implemented for claims appearing on the March 5, 2021
checkwrite going forward. If you have questions about the changes or how to test,
please contact interChange_Testing@dxc.com.
In order to assess the impact of
these changes we request taking the following steps:
- 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.
- 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.
- Participate in
835 Electronic Remittance Advice Testing
User
Acceptance Testing is currently underway. 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, or to the email address
provider below.
These changes are currently
available in UAT for Provider and Vendor testing. Testing should be completed
by February 16, 2021. The updated reporting will be implemented for claims
appearing on the March 5, 2021 checkwrite going forward.
Providers with questions
concerning the upcoming changes can submit them via the following email
address: interChange_Testing@dxc.com.
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