New Loops/Segments

For new loops, the change log will only reflect the new loop identifier and name and associated segments. For new segments added to existing loops, the change log will only reflect the segment name.

Non-substantive Changes

Changes considered by the work group to be non-substantive in nature will not appear in the change log. This includes changes to correct typographical or grammatical errors, updated examples, reformatted text, updated industry names, and modifications to rules and notes either for consistency across TR3s or for proper textual construct that did not change the note's original intent.

Location X322 | Health Care Claim Payment/Advice
1.3 Implementation Limitations
Action Modify Chapter 1
Section 1.3.1 Batch and Real-Time Usage 7030 content Paragraph 4
CR 1037 To incorporate real-time claim processing and adjudication information into the TR3.
Location X322 | Health Care Claim Payment/Advice
1.4 Business Usage
Action Modify Chapter 1
Section 1.4.2 Information Flows, paragraph 1
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice
1.5 Business Terminology
Action Add Chapter 1
Section 1.5 Business Terminology

New Term Added:
IISRC - Insurance industry Specific Remark Codes
CR 1234 There are industries that need very specific regulatory language for reasons that DO NOT fit into the criteria for the Remittance Advice Remark Code. These would also not be appropriate for CARC codes. So a new list is needed for "Industry specific Remark Codes" that will welcome other industries needs for ISRC 's. "Industry specific Remark Codes" are codes needed in the respective industry that do not meet the criteria for CARC or RARC committees.
Location X322 | Health Care Claim Payment/Advice
1.5 Business Terminology
Action Modify Chapter 1
Section 1.5 Business Terminology

Add: Real Time Adjudication
CR 1037 To incorporate real-time claim processing and adjudication information into the TR3.
Location X322 | Health Care Claim Payment/Advice
1.5 Business Terminology
Action Modify Chapter 1
Section 1.5 Business Terminology, add:
Real Time Predetermination/Estimation
CR 1037 To incorporate real-time claim processing and adjudication information into the TR3.
Location X322 | Health Care Claim Payment/Advice
1.5 Business Terminology
Action Modify Chapter 1
Section 1.5 Business Terminology
Add Self-Insured Plan
CR 1499 Section 1.5 - Change term for existing definition of "Plan" to "Self-insured Plan". Add a more generic "Plan" definition describing all plans.
Location X322 | Health Care Claim Payment/Advice
1.5 Business Terminology
Action Modify Chapter 1
Section 1.5 Business Terminology

Add: Forced balancing
CR 1076 Guidance to payers (front matter section) on how to handle out of balance situations, include info from Operating rules
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.1.3 Electronic Funds Transfer - revise entire section
CR 1450 835 Front matter section 1.10.1.3 includes a table listing file formats for various stages of the payment process, and 2 notes to the table. This table needs to be reviewed based upon the new EFT requirements, and the NOTES included need to be revised as it is confusing having 2 separate notes.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.4, Paragraph 7 CARCs with Required Remark Codes
CR 1033 Update front matter sections 1.10.2.4.3 and 1.10.2.4.4 to remove the reference to the old section of the CARC/RARC TR2.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.4.5 Claim Adjustment Group Code Usage - revise entire section
CR 1461 Need clarification to ensure understanding of the use of all existing Group Codes. It is not always completely clear when to use CO versus OA, for example, so descriptions need to be reviewed and clarified to eliminate confusion.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.11. Claim Splitting, Paragraph 5
CR 654 RFI 467 - line splitting. Include details from HIR about what lines must look like if split (same line control number, sum of charges must equal original billed charge, etc).
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.13 Secondary Payment Reporting Considerations - revise entire section
CR 1096 Update Section 1.10.2.13 Secondary Payment Reporting Considerations to clarify how amounts are reported for COB payments.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.14.1 Reporting Invalid or Unrecognized Procedure Information (SVC01 / SVC06) in the 835 - inserted new section
CR 685 Clarify what should be reported in SVC01 and SVC06 when invalid procedure / service codes come in on the claim (e.g. paper). How should the original bad code be reported in the 835 to show what came in versus what was adjudicated?
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.17 Claim Overpayment Recovery - revise entire section
CR 1034 Review front matter section 1.10.2.17 Overpayment Recovery and re-evaluate the directions for the industry.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
1.10.2.21 835 Message Matching - add new section
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.25 Real-Time Claim Processing - add new section
CR 1037 To incorporate real-time claim processing and adjudication information into the TR3.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.1.2.6 ERA with Payment by Card, add new section
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.1.4 Card Payments in the 835 - add new section
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.26 Funds Not Available - add new section
CR 1070 Payer has no money to pay the RA but has an 835 created. Need direction/rule on what to do with the 835.

Front matter section - giving guidance on how to handle the 835 in this situation.
Providers and payers across the industry need direction.
Providers tend to not post the 835 until the money has been received.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.1.1 Service Line Balancing - revise entire section
CR 1103 Front Matter section on balancing for professional claims - refine rules to report RAS ONLY at service level. Need stronger language to force professional claims to be service line only.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
1.10.2.1.2 Claim Balancing - last paragraph
CR 1461 Need clarification to ensure understanding of the use of all existing Group Codes. It is not always completely clear when to use CO versus OA, for example, so descriptions need to be reviewed and clarified to eliminate confusion.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.4.3 Claim Adjustment Reason Code (CARC) Usage - revise entire section
CR 1466 Section 1.10.2.13 includes a definition of CARC 23 which does not match the currect CARC description. In addition, an update to that description has been proposed. The front matter section should be updated to reflect the correct CARC description.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.4.4 Remark Codes - Revise entire section
CR 1466 Section 1.10.2.13 includes a definition of CARC 23 which does not match the currect CARC description. In addition, an update to that description has been proposed. The front matter section should be updated to reflect the correct CARC description.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
1.10.2.6 Procedure Code Bundling and Unbundling, paragraph 4
CR 1461 Need clarification to ensure understanding of the use of all existing Group Codes. It is not always completely clear when to use CO versus OA, for example, so descriptions need to be reviewed and clarified to eliminate confusion.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.6 Procedure Code Bundling and Unbundling, Bundling Example
CR 1091 The Bundling section states to adjust off the non-paying service lines using the RAS segment, and the example shows the SVC reporting "0" paid units. But, the RAS segment instructions and example don't include usage of the RAS quantity. Since we have added instructions about the quantity usage at other places, shouldn't we include it here? From an implicit balancing perspective, we should be stating to use the RAS Adjustment Quantity with the OA*94 adjustment to reduce the units to zero for each of the services that aren't paying. Only the primary service line that includes the payment shows paying units and the others should balance out appropriately.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
1.10.2.7 Predetermination of Benefits Paragraph 1 - revise entire section
CR 1461 Need clarification to ensure understanding of the use of all existing Group Codes. It is not always completely clear when to use CO versus OA, for example, so descriptions need to be reviewed and clarified to eliminate confusion.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.10 Capitation and Related Payments or Adjustments paragraph 1
CR 1427 Wording should be reviewed and corrected in section 1.10.2.10 where there is a reference to the 271 transaction's Reassociation Key Segment, which doesn't exist. In a future guide this should be updated to point to the TRN - Information Source Trace number.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.10 Capitation and Related Payments or Adjustments paragraph 4
CR 1427 Wording should be reviewed and corrected in section 1.10.2.10 where there is a reference to the 271 transaction's Reassociation Key Segment, which doesn't exist. In a future guide this should be updated to point to the TRN - Information Source Trace number.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
Section 1.10.2.15 PPOs, Networks and Contract Types, Paragraph 3
CR 1461 Need clarification to ensure understanding of the use of all existing Group Codes. It is not always completely clear when to use CO versus OA, for example, so descriptions need to be reviewed and clarified to eliminate confusion.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
1.10.2.22 Billing Provider as Payee - revise entire section
CR 1074 Section 1.10.2.22 Billing Provider as Payee, Review direction of NPI. Offer more direction, include information from operating rules as applicable.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Delete Chapter 1
Section 1.10.2.4.2 Claim/Service Adjustment Information Segment, Bulleted List.

- the entire claim submitted charge is being adjusted by this RAS segment

- and there are multiple adjustment reasons that are each applicable for the adjustment of that full amount in RAS01.
CR 1079 The RAS segment is used in the 837 and 835 transaction. The associated TR3s need additional explanation related to correct use of the segment. Consider including the expanded explanation in the front matter.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Add Chapter 1
Section 1.10.2.20 Retroactive Claim Adjustments
CR 644 Add front matter section detailing the use of RARC codes that were created to be used for Retroactive Claim Adjustments.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Delete Chapter 1
1.10.2.10 Capitation and Related Payments or Adjustments, bulleted item 2.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
1.10.3.1 835 Message Matching, paragraph 3.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Delete Chapter 1
1.10.3.1 835 Message Matching, paragraph 5.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice
1.10 Data Overview
Action Modify Chapter 1
1.10.3.1 835 Message Matching, paragraph 6.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100
ST - Transaction Set Header
Action Modify Data Element Usage
ST03 Change from Not Used to Required
CR 1338 To promote consistency across all guides.
Location X322 | Health Care Claim Payment/Advice | 835 | 0200
BPR - Financial Information
Action Add Data Element Code Value
BPR01 Add qualifier K (Reimbursement to Follow) with code note for use with Real-Time Adjudication.
CR 1564 To enhance transaction functionality
Location X322 | Health Care Claim Payment/Advice | 835 | 0200
BPR - Financial Information
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 0200
BPR - Financial Information
Action Modify Data Element Code Note
Header/BPR03 (Credit/Debit Flag Code)

C - Credit - Added instructions for card payments.
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice | 835 | 0200
BPR - Financial Information
Action Modify Data Element Code Note
Header/BPR03 (Credit/Debit Flag Code)

D - Debit - Added instructions for card payments.
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice | 835 | 0200
BPR - Financial Information
Action Add Data Element Code Value
Header/BPR04 (Payment Method Code)

CCC - Credit Card, with code notes.
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice | 835 | 0200
BPR - Financial Information
Action Add Data Element Code Value
Header/BPR04 (Payment Method Code)

DEB - Debit Card, with code notes.
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice | 835 | 0200
BPR - Financial Information
Action Modify Data Element Note
Header/BPR16 (Date)

Added instructions for BOP and card payments.
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400
TRN - Reassociation Trace Number
Action Modify Data Element Industry Name
Header/TRN02 (Reference Identification)

Added information for card payments
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400
TRN - Reassociation Trace Number
Action Add Data Element Note
TRN02 - add note on size restriction
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400
TRN - Reassociation Trace Number
Action Modify Data Element Note
Header/TRN02 (Reference Identification)

Added instructions for EFT, BOP, and card payments
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400
TRN - Reassociation Trace Number
Action Modify Data Element Note
Header/TRN04 (Reference Identification)
- Added clarification on relationship with BPR11 and size restrictions
CR 1394 The TRN04 element note needs to be revised and a clarifying comment providing guidance on when BPR11 is "used" or "not used" in conjunction with TRN04 is needed.
Location X322 | Health Care Claim Payment/Advice
REF - Card Security Verification Code
Action Add Segment
Header / REF (Card Security Verification Code) - Add segment as situational, with situational rule, and qualifier AFC (Verification Source Code)
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice
DTM - Card Expiration Date
Action Add Segment
Header / DTM (Card Expiration Date) - Add Segment, Segment Situational Rule, Data Element DTM01 qualifier 036 (Expiration) with note, and DTM02 note
CR 1265 Allow for card payments (p-card, debit card, and credit card) within the 835 and related X12 transactions so remittance information can be conveyed electronically in these scenarios.
Location X322 | Health Care Claim Payment/Advice | 835 | 0800 | 1000A
N1 - Payer Identification
Action Add Data Element Note
Loop ID 1000A / N102 - Add Note reflecting the Operating Rule requirements
CR 1101 N1 Payer Name - Name the provider knows the payer by, match the CCD+

NACHA Operating Rules update requires the Payer Name in the CCD+ file to be the name the provider will recognize, the name the provider knows the payer by. Name listed in the 835 should match this name.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Business Contact Information
Action Modify Segment Repeat
Loop ID 1000A PER (Payer Business Contact) - Modified Segment Repeat from 1 to 2
CR 132 1000A Payer Technical and Business Contact PER Segments need notes reflecting the relationship between PER02 and PER04.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Business Contact Information
Action Modify Data Element Usage
Loop ID 1000A / PER03, - Update PER03 to Required
CR 132 1000A Payer Technical and Business Contact PER Segments need notes reflecting the relationship between PER02 and PER04.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Business Contact Information
Action Modify Data Element Usage
Loop ID 1000A / PER04, - Update PER04 to Required
CR 132 1000A Payer Technical and Business Contact PER Segments need notes reflecting the relationship between PER02 and PER04.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Business Contact Information
Action Modify Data Element Situational Rule
Changed to "Required when PER03 is used and a contact communication number is to be transmitted. If not required by this implementation guide, do not send."
CR 132 1000A Payer Technical and Business Contact PER Segments need notes reflecting the relationship between PER02 and PER04.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Technical Contact Information
Action Modify Segment Repeat
Loop ID 1000A PER (Payer Technical Contact) - Modify Segment Repeat from >1 to 2
CR 132 1000A Payer Technical and Business Contact PER Segments need notes reflecting the relationship between PER02 and PER04.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Technical Contact Information
Action Modify Segment Usage
Loop ID 1000A / PER - Payer Technical Contact Information: Update segment usage to Situational with Situational Rule
CR 132 1000A Payer Technical and Business Contact PER Segments need notes reflecting the relationship between PER02 and PER04.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Technical Contact Information
Action Add Segment Note
Loop ID 1000A / PER (Payer Technical Contact Information) - Add Segment Note regarding format of telephone information.
CR 132 1000A Payer Technical and Business Contact PER Segments need notes reflecting the relationship between PER02 and PER04.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Technical Contact Information
Action Modify Data Element Usage
Loop ID 1000A / PER (Payer Technical Contact Information) PER02, - Update PER02 to Situational
CR 132 1000A Payer Technical and Business Contact PER Segments need notes reflecting the relationship between PER02 and PER04.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Technical Contact Information
Action Modify Data Element Usage
Loop ID 1000A / PER (Payer Technical Contact Information) PER03 - Update PER03 to Required
CR 132 1000A Payer Technical and Business Contact PER Segments need notes reflecting the relationship between PER02 and PER04.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Technical Contact Information
Action Modify Data Element Usage
Loop ID 1000A / PER (Payer Technical Contact Information) PER04 - Update PER04 to Required
CR 132 1000A Payer Technical and Business Contact PER Segments need notes reflecting the relationship between PER02 and PER04.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Technical Contact Information
Action Modify Data Element Situational Rule
Changed to "Required when PER03 is used and a contact communication number is to be transmitted. If not required by this implementation guide, do not send."
CR 132 1000A Payer Technical and Business Contact PER Segments need notes reflecting the relationship between PER02 and PER04.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Website Contact Information
Action Modify Segment Name
Loop ID 1000A PER - Payer Website Contact Information: Update Segment Name to include "Contact Information
CR 1367 To enable the use of the PER segment for notification claims and payment determination methodology.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Website Contact Information
Action Modify Segment Repeat
Loop ID 1000A PER (Payer Website Contact Information) Modify Segment Repeat from 1 to 2
CR 1367 To enable the use of the PER segment for notification claims and payment determination methodology.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Website Contact Information
Action Modify Segment Situational Rule
Loop ID 1000A PER - Payer Website Contact Information: Update Segment Situational Rule to include relationships to REF segments.
CR 1367 To enable the use of the PER segment for notification claims and payment determination methodology.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 1000A
PER - Payer Website Contact Information
Action Add Segment Note
Loop ID 1000A PER (Payer Website Contact Information) Add Segment Notes
CR 1367 To enable the use of the PER segment for notification claims and payment determination methodology.
Location X322 | Health Care Claim Payment/Advice | 835 | 0800 | 1000B
N1 - Payee Identification
Action Modify Data Element Usage
Loop ID 1000B N1 (Payee Identification) N103 - Update to Situational with Situational Rule update to reflect relationship to N104
CR 1102 Strengthen rule requiring Tax ID in the 835 when it is not the primary identifier of the payee. If the TIN is not the primary ID in the N1, there is still a need for TIN as Payee Additional Identifier for Tax reporting and 1099 processing because this is a financial transaction. The REF*TJ must be reported to include the TIN in the 835.
Location X322 | Health Care Claim Payment/Advice | 835 | 0800 | 1000B
N1 - Payee Identification
Action Add Data Element Note
Loop ID 1000B N1 (Payee Identification) N103 - Add Data Element Note referring to front matter section 1.10.2.22
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0800 | 1000B
N1 - Payee Identification
Action Modify Data Element Code Value
Loop ID 1000B N1 (Payee Identification) N103 - Remove code value FI. Code Value XX - Remove Note. Code Value XV Update note to include HPID and OEID.
CR 1102 Strengthen rule requiring Tax ID in the 835 when it is not the primary identifier of the payee. If the TIN is not the primary ID in the N1, there is still a need for TIN as Payee Additional Identifier for Tax reporting and 1099 processing because this is a financial transaction. The REF*TJ must be reported to include the TIN in the 835.
Location X322 | Health Care Claim Payment/Advice | 835 | 0800 | 1000B
N1 - Payee Identification
Action Modify Data Element Usage
Loop ID 1000B N1 (Payee Identification) N104 - Update to Situational, Add situational rule
CR 1102 Strengthen rule requiring Tax ID in the 835 when it is not the primary identifier of the payee. If the TIN is not the primary ID in the N1, there is still a need for TIN as Payee Additional Identifier for Tax reporting and 1099 processing because this is a financial transaction. The REF*TJ must be reported to include the TIN in the 835.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 1000B
N3 - Payee Address
Action Modify Segment Situational Rule
Loop ID 1000B N3 and N4 - Update Segment Situational Rule to add relationship to BPR and RDM
CR 684 1000B N4 segment (Payee City, State, Zip) - Change to Situational and require when a physical address is needed to communicate the payee address to the transaction receiver.
Location X322 | Health Care Claim Payment/Advice | 835 | 1100 | 1000B
N4 - Payee City, State, ZIP Code
Action Modify Segment Situational Rule
Loop ID 1000B N3 and N4 - Update Segment Situational Rule to add relationship to BPR and RDM
CR 684 1000B N4 segment (Payee City, State, Zip) - Change to Situational and require when a physical address is needed to communicate the payee address to the transaction receiver.
Location X322 | Health Care Claim Payment/Advice | 835 | 1200 | 1000B
REF - Payee Additional Identification
Action Modify Segment Repeat
from >1 to 4.
CR 1205 Modify repeat count to coincide with the available number of qualifiers.
Location X322 | Health Care Claim Payment/Advice | 835 | 1200 | 1000B
REF - Payee Additional Identification
Action Delete Data Element Code Value
REF- Payee Additional Identification: Delete code TJ. Code TJ (Federal Taxpayer's Identification Number) is moved to the new REF - Payee Tax Identification Segment
CR 1102 Strengthen rule requiring Tax ID in the 835 when it is not the primary identifier of the payee. If the TIN is not the primary ID in the N1, there is still a need for TIN as Payee Additional Identifier for Tax reporting and 1099 processing because this is a financial transaction. The REF*TJ must be reported to include the TIN in the 835.
Location X322 | Health Care Claim Payment/Advice | 835 | 1400 | 1000B
RDM - Remittance Delivery Method
Action Modify Segment Situational Rule
Loop ID 1000B RDM Update Segment Situational Rule to remove requirement for payers to instruct banks
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 1400 | 1000B
RDM - Remittance Delivery Method
Action Modify Segment Note
Loop ID 1000B RDM - Update Segment Note to reflect that both Payer and Payee must coordinate on remittance delivery
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0050 | 2000
TS3 - Provider Summary Information
Action Modify Segment Situational Rule
TS3 - Modify Segment Situational Rule to remove requirement for Medicare Part A
CR 669 Modify TS3 Segment Situational Rule to remove reference to Medicare as there are other situations where this segment is needed.
Location X322 | Health Care Claim Payment/Advice | 835 | 0050 | 2000
TS3 - Provider Summary Information
Action Modify Segment Note
TS3 - Modify segment note to clarify "inpatient" versus "Part A
CR 669 Modify TS3 Segment Situational Rule to remove reference to Medicare as there are other situations where this segment is needed.
Location X322 | Health Care Claim Payment/Advice | 835 | 0050 | 2000
TS3 - Provider Summary Information
Action Modify Data Element Note
TS304 - Data Element Note updated to clarify definition of total number of claims
CR 1089 TS3 Balancing. Clarify balancing within the TS3 (Provider Summary Information Segment). In the pharmacy industry it is typical to balance at this level especially in the chain arena.
Include: claim count, clarify how to count, especially regarding correction & reversals
Location X322 | Health Care Claim Payment/Advice | 835 | 0050 | 2000
TS3 - Provider Summary Information
Action Modify Data Element Note
TS305 - Data Element Note updated to clarify definition of total reported charges
CR 1089 TS3 Balancing. Clarify balancing within the TS3 (Provider Summary Information Segment). In the pharmacy industry it is typical to balance at this level especially in the chain arena.
Include: claim count, clarify how to count, especially regarding correction & reversals
Location X322 | Health Care Claim Payment/Advice | 835 | 0050 | 2000
TS3 - Provider Summary Information
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 0070 | 2000
TS2 - Provider Supplemental Summary Information
Action Modify Data Element Situational Rule
TS201 - Modify situational rule to require based upon total noncovered day count instead of DRG amount.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0070 | 2000
TS2 - Provider Supplemental Summary Information
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 0070 | 2000
TS2 - Provider Supplemental Summary Information
Action Modify Data Element Situational Rule
TS214 - Modify situational rule to include reference to front matter section 1.10.2.4.4
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Add Data Element Code Value
Loop ID 2100 CLP (Claim Payment Information) CLP11-01 - Add DRG code values and notes explaining usage.
CR 1047 The 835 needs to allow for greater length in the DRG code, in addition to multiple DRG lists (along with a way to differentiate which DRG methodology was used in adjudication).
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Modify Data Element Industry Name
CLP01 - Change Industry Name to Provider's Assigned Claim Identifier
CR 123 CLP01- revise the rule to be consistent with other TR3s and to require a unique ID.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Modify Data Element Note
Loop ID 2100 CLP (Claim Payment Information) CLP01 Modify Note to clarify content of element and requirement to return what was submitted on the claim.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Delete Data Element Code Value
4 Denied
CR 1469 In 5010, the meaning of qualifier 4 was changed so that it no longer reflected an overall denial, but should only be used if the Patient/Subscriber is not recognized, and the claim was not forwarded to another payer. Many payers have not correctly modified their systems to reflect this change, and so claims returned with qualifier 4 cannot be accurately determined if the reason was "denial" or the correct reason of "patient/subscriber not recognized." It would be better to sunset qualifier 4 and introduce a new qualifier for the "patient / subscriber not recognized" reason so that the intention of the CLP02 is very clear.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Add Data Element Code Value
CLP02 Add Code Value 35 Patient/Subscriber Not Recognized
with notes.
CR 1469 In 5010, the meaning of qualifier 4 was changed so that it no longer reflected an overall denial, but should only be used if the Patient/Subscriber is not recognized, and the claim was not forwarded to another payer. Many payers have not correctly modified their systems to reflect this change, and so claims returned with qualifier 4 cannot be accurately determined if the reason was "denial" or the correct reason of "patient/subscriber not recognized." It would be better to sunset qualifier 4 and introduce a new qualifier for the "patient / subscriber not recognized" reason so that the intention of the CLP02 is very clear.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Delete Data Element Code Value
CLP02 Delete Code Value 22 Reversal of Previous Payment - replaced with new codes
CR 1044 Need to include qualifiers in CLP02 for reversal and secondary claim, reversal and tertiary claim to reflect the priority of payer, which is currently lost in reversals.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Modify Data Element Situational Rule
CLP05 Situational Rule update to clarify when patient responsibility must be reported.
CR 1600 Values within the 835 should be validated based on other values internal to the same 835 when possible.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Modify Data Element Usage
Loop ID 2100 CLP (Claim Payment Information) CLP06 (Claim Filing Indicator) change to Not Used.
CR 1032 The Public Health Data Standards Consortium has developed and maintains an external code set for the Source of Payment Typology. This code source was developed to address the limitations and deficiencies in the existing X12 internal Claim Filing Indicator (Data Element 1032) code set.
The Source of Payment typology has already been added to the X12 standards for use in the claim standard. Including the additional detail of this value in the 835 is beneficial. In addition, CMS includes the Payer Typology as one of the required supplemental variables for quality e-measures (for the CMS 2014 Meaningful Use Clinical Quality Measures). Several states have adopted the Source of Payment Typology in their statewide hospital administrative data. Because it is used by CMS and in state requirements, it is necessary to include in the 835.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Modify Data Element Usage
CLP11 - Update to situational, with situational rule updated to remove requirement for institutional claims
CR 1047 The 835 needs to allow for greater length in the DRG code, in addition to multiple DRG lists (along with a way to differentiate which DRG methodology was used in adjudication).
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Add Data Element
CLP15 - Add New Data Element Claim Exchange Rate as Situational, with situational rule and note.
CR 675 To indicate the currency of the claim if it is different that the claim payment.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Add Data Element
CLP16 - Add New Data Element Source of Payment Typology Code as Required with note. Usage of this element replaces CLP06.
CR 1032 The Public Health Data Standards Consortium has developed and maintains an external code set for the Source of Payment Typology. This code source was developed to address the limitations and deficiencies in the existing X12 internal Claim Filing Indicator (Data Element 1032) code set.
The Source of Payment typology has already been added to the X12 standards for use in the claim standard. Including the additional detail of this value in the 835 is beneficial. In addition, CMS includes the Payer Typology as one of the required supplemental variables for quality e-measures (for the CMS 2014 Meaningful Use Clinical Quality Measures). Several states have adopted the Source of Payment Typology in their statewide hospital administrative data. Because it is used by CMS and in state requirements, it is necessary to include in the 835.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100 | 2100
CLP - Claim Payment Information
Action Add Data Element Code Note
"Use for overpayment recovery electronic notification claim. See Section 1.10.2.17 option 3 for additional information."
CR 680
Location X322 | Health Care Claim Payment/Advice | 835 | 0250 | 2100
RAS - Claim Adjustment Information
Action Add Segment
Delete Segment CAS.

Add Segment RAS - Claim Adjustment Information. The RAS segment is Situational, with situational rule and notes.

The RAS segment replaces the CAS segment for reporting adjustment codes and amounts, and also includes reporting remark codes associated to a CARC.
CR 105 RAS Segment: Inclusion of this segment supports multiple CARCs for a single dollar amount. It also allows association of remark codes to a specific CARC.
Location X322 | Health Care Claim Payment/Advice | 835 | 0250 | 2100
RAS - Claim Adjustment Information
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 0250 | 2100
RAS - Claim Adjustment Information
Action Add Data Element Code Value
Loop ID 2100/RAS03-02 (Code List Qualifier Code) RM - Insurance Industry Specific Remark Codes. New external code list to provide remark codes not in the Remittance Advice Remark Code list.
CR 1234 There are industries that need very specific regulatory language for reasons that DO NOT fit into the criteria for the Remittance Advice Remark Code. These would also not be appropriate for CARC codes. So a new list is needed for "Industry specific Remark Codes" that will welcome other industries needs for ISRC 's. "Industry specific Remark Codes" are codes needed in the respective industry that do not meet the criteria for CARC or RARC committees.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Patient Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Patient Name) NM103 - Updated Situational Rule to include requirement for submission if on original claim.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Patient Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Patient Name) NM104 - Updated Situational Rule to require submission if on the original claim.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Patient Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Patient Name) NM105 - Updated Situational Rule to require submission if on the original claim.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Patient Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Patient Name) NM107 - Updated Situational Rule to require submission if on the original claim.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Patient Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Patient Name) NM109 - Updated Situational Rule to require submission if on the original claim.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Subscriber Name
Action Modify Segment Name
Loop ID 2100 NM1 Modify Segment Name from "Insured" to "Subscriber".
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Subscriber Name
Action Modify Segment Note
NM1 Subscriber Name - Modify Segment Note to clarify that corrected information is not reported in this segment.
CR 1081 NM1 Note, review NM1 Subscriber TR3 note to confirm this is accurate for how the 837 now works w/ patient and subscriber
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Subscriber Name
Action Modify Segment Note
NM1 Subscriber Name - Modify Segment Note to require that this report the information submitted on the original claim.
CR 1081 NM1 Note, review NM1 Subscriber TR3 note to confirm this is accurate for how the 837 now works w/ patient and subscriber
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Subscriber Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Subscriber Name) NM103 - Updated Situational Rule to require submission if on the original claim.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Subscriber Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Subscriber Name) NM104 - Updated Situational Rule to require submission if on the original claim.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Subscriber Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Subscriber Name) NM105 - Updated Situational Rule to require submission if on the original claim.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Subscriber Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Subscriber Name) NM107 - Updated Situational Rule to require submission if on the original claim.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Subscriber Name
Action Modify Data Element Usage
Loop ID 2100 NM1 (Subscriber Name) NM108 - Update to Situational with Situational Rule to reflect relationship to NM109
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Subscriber Name
Action Modify Data Element Usage
Loop ID 2100 NM1 (Subscriber Name) NM109 - Updated to Situational with Situational Rule to require submission if on the original claim.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Corrected Patient/Subscriber Name
Action Modify Segment Name
NM1 Corrected Patient / Subscriber Name - Change Segment Name and other instances of "Insured" to "Subscriber"
CR 1082 Corrected Patient / Insured Segment - Update to coordinate with changes to the 837 regarding insured versus subscriber. Also need to include patient correction ability and ability to report corrected patient information when the payer's information differs from the submitted claim.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Corrected Patient/Subscriber Name
Action Modify Segment Repeat
Modify Segment Repeat from 1 to 2.
CR 630 Support reporting of the adjudicated patient name when it is different from the submitted patient name.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Corrected Patient/Subscriber Name
Action Modify Segment Situational Rule
NM1 Corrected Patient / Subscriber Name - Modify Segment Situational Rule to include relationship to information submitted on the claim.
CR 629 Support reporting of the adjudicated patient name when it is different from the submitted patient name.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Corrected Patient/Subscriber Name
Action Add Segment Note
NM1 Corrected Patient / Subscriber Name - Add note requiring information from the payer's system.
CR 629 Support reporting of the adjudicated patient name when it is different from the submitted patient name.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Corrected Patient/Subscriber Name
Action Delete Segment Note
Remove Note #1
CR 1082 Corrected Patient / Insured Segment - Update to coordinate with changes to the 837 regarding insured versus subscriber. Also need to include patient correction ability and ability to report corrected patient information when the payer's information differs from the submitted claim.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Corrected Patient/Subscriber Name
Action Modify Data Element Code Value
NM101 - Remove code 74 (Corrected Insured). Add codes COP (Corrected Patient) and COS ( Corrected Subscriber).
CR 1082 Corrected Patient / Insured Segment - Update to coordinate with changes to the 837 regarding insured versus subscriber. Also need to include patient correction ability and ability to report corrected patient information when the payer's information differs from the submitted claim.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Corrected Patient/Subscriber Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Corrected Patient / Subscriber Name) NM103 (Last Name) - changed requirement to include only when adjudicated is different than what was submitted on the claim.
CR 1082 Corrected Patient / Insured Segment - Update to coordinate with changes to the 837 regarding insured versus subscriber. Also need to include patient correction ability and ability to report corrected patient information when the payer's information differs from the submitted claim.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Corrected Patient/Subscriber Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Corrected Patient / Subscriber Name) NM104 - Update Situational Rule to require when information differs from that submitted on the original claim.
CR 1082 Corrected Patient / Insured Segment - Update to coordinate with changes to the 837 regarding insured versus subscriber. Also need to include patient correction ability and ability to report corrected patient information when the payer's information differs from the submitted claim.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Corrected Patient/Subscriber Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Corrected Patient / Subscriber Name) NM105 - Update to require submission when different than what was submitted on the claim.
CR 1082 Corrected Patient / Insured Segment - Update to coordinate with changes to the 837 regarding insured versus subscriber. Also need to include patient correction ability and ability to report corrected patient information when the payer's information differs from the submitted claim.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Corrected Patient/Subscriber Name
Action Modify Data Element Situational Rule
Loop ID 2100 NM1 (Corrected Patient / Subscriber Name) NM107 - Update Situational Rule to require when information differs from that submitted on the claim.
CR 1082 Corrected Patient / Insured Segment - Update to coordinate with changes to the 837 regarding insured versus subscriber. Also need to include patient correction ability and ability to report corrected patient information when the payer's information differs from the submitted claim.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Corrected Patient/Subscriber Name
Action Modify Data Element Code Value
NM108 - Corrected Patient / Subscriber Name - Remove code C (Insured's Changed Unique Identification Number). Add code IN (Changed Unique Identification Number).
CR 1082 Corrected Patient / Insured Segment - Update to coordinate with changes to the 837 regarding insured versus subscriber. Also need to include patient correction ability and ability to report corrected patient information when the payer's information differs from the submitted claim.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Service Provider Name
Action Modify Segment Situational Rule
Loop ID 2100, NM1 Segment (Rendering Provider Name)

Changed Situational Rule and other instances of Rendering Provider to Service Provider.
CR 1135 NUCC's definition of a rendering provider is: The Rendering Provider is the individual who provided the care. In the case where a substitute provider (locum tenens) was used, that individual is considered the Rendering Provider.

The Rendering Provider does not include individuals performing services in support roles, such as lab technicians or radiology technicians.

Therefore alignment is necessary to ensure that consistency between definition & usage within transaction.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Service Provider Name
Action Modify Data Element Code Value
Loop ID 2100, NM101 (Entity Identifier Code)

Remove code 82 (Rendering Provider). Add code SJ (Service Provider).
CR 1135 NUCC's definition of a rendering provider is: The Rendering Provider is the individual who provided the care. In the case where a substitute provider (locum tenens) was used, that individual is considered the Rendering Provider.

The Rendering Provider does not include individuals performing services in support roles, such as lab technicians or radiology technicians.

Therefore alignment is necessary to ensure that consistency between definition & usage within transaction.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Service Provider Name
Action Delete Segment Note
This segment provides information about the rendering provider. An identification number is provided in NM109.
CR 1181 For consistency across TR3's, Recommend Changing the name of the Location Identification 2100 REF to Additional Rendering Provider Identification Number (Currently the Location Identification segment) include both the LU and A6 to carry the payer assigned identifiers; increase the repeat to '2'. The Code LU and A6 should be consistent with the notes in the claim. This would result in removing the 'SV' qualifier from the NM108 for Rendering Provider and change from required to situational - this is consistent with the way the 837.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Service Provider Name
Action Modify Data Element Usage
NM1 Service Provider Name NM108 - Change element from Required to Situational and modify situational rule to clarify NPI requirements
CR 1181 For consistency across TR3's, Recommend Changing the name of the Location Identification 2100 REF to Additional Rendering Provider Identification Number (Currently the Location Identification segment) include both the LU and A6 to carry the payer assigned identifiers; increase the repeat to '2'. The Code LU and A6 should be consistent with the notes in the claim. This would result in removing the 'SV' qualifier from the NM108 for Rendering Provider and change from required to situational - this is consistent with the way the 837.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Service Provider Name
Action Delete Data Element Code Value
NM1 Service Provider Name NM108 - Delete all code values except XX (Standard Unique Health Identifier for Health Care Providers (NPI)).
CR 1366 Align with NPI Rule.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Service Provider Name
Action Modify Data Element Usage
Loop ID 2100 NM1 Service Provider Name NM109 - Change element from Required to Situational and modify situational rule to clarify NPI requirements.
CR 1181 For consistency across TR3's, Recommend Changing the name of the Location Identification 2100 REF to Additional Rendering Provider Identification Number (Currently the Location Identification segment) include both the LU and A6 to carry the payer assigned identifiers; increase the repeat to '2'. The Code LU and A6 should be consistent with the notes in the claim. This would result in removing the 'SV' qualifier from the NM108 for Rendering Provider and change from required to situational - this is consistent with the way the 837.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Crossover Carrier Name
Action Modify Segment Repeat
Revise Segment Repeat from 1 to 10
CR 1043 Need to report the Crossover NM1 segment with multiple occurrences. Also need to report more Corrected Priority Payers.
Location X322 | Health Care Claim Payment/Advice | 835 | 0300 | 2100
NM1 - Crossover Carrier Name
Action Add Segment Note
TR3 Note:
2. When the claim is transferred to more than 1 carrier, use this segment to report all crossover names and reference numbers.
CR 1043 Need to report the Crossover NM1 segment with multiple occurrences. Also need to report more Corrected Priority Payers.
Location X322 | Health Care Claim Payment/Advice | 835 | 0330 | 2100
MIA - Inpatient Adjudication Information
Action Modify Segment Situational Rule
Modify Loop ID 2100/ MIA Segment Situational Rule to remove reference to Remark Code list.
CR 1234 There are industries that need very specific regulatory language for reasons that DO NOT fit into the criteria for the Remittance Advice Remark Code. These would also not be appropriate for CARC codes. So a new list is needed for "Industry specific Remark Codes" that will welcome other industries needs for ISRC 's. "Industry specific Remark Codes" are codes needed in the respective industry that do not meet the criteria for CARC or RARC committees.
Location X322 | Health Care Claim Payment/Advice | 835 | 0330 | 2100
MIA - Inpatient Adjudication Information
Action Delete Segment Note
Loop ID 2100/MIA Segment

When used outside of the Medicare and Medicaid community only MIA01, 05, 20, 21, 22 and 23 may be used.
CR 1234 There are industries that need very specific regulatory language for reasons that DO NOT fit into the criteria for the Remittance Advice Remark Code. These would also not be appropriate for CARC codes. So a new list is needed for "Industry specific Remark Codes" that will welcome other industries needs for ISRC 's. "Industry specific Remark Codes" are codes needed in the respective industry that do not meet the criteria for CARC or RARC committees.
Location X322 | Health Care Claim Payment/Advice | 835 | 0330 | 2100
MIA - Inpatient Adjudication Information
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 0330 | 2100
MIA - Inpatient Adjudication Information
Action Modify Data Element Usage
Modify all Loop ID 2100/MIA segment Remark Code elements (MIA05, MIA20, MIA21, MIA22, MIA23) to Not Used. Remark Codes are now reported in either a RAS Segment (when associated with a CARC) or an LQ Segment.
CR 1234 There are industries that need very specific regulatory language for reasons that DO NOT fit into the criteria for the Remittance Advice Remark Code. These would also not be appropriate for CARC codes. So a new list is needed for "Industry specific Remark Codes" that will welcome other industries needs for ISRC 's. "Industry specific Remark Codes" are codes needed in the respective industry that do not meet the criteria for CARC or RARC committees.
Location X322 | Health Care Claim Payment/Advice | 835 | 0350 | 2100
MOA - Outpatient Adjudication Information
Action Modify Segment Situational Rule
Loop ID 2100/MOA Segment (Outpatient Adjudication Information)

Modify Loop ID 2100/ MOA Segment Situational Rule to remove reference to Remark Code list.
CR 1234 There are industries that need very specific regulatory language for reasons that DO NOT fit into the criteria for the Remittance Advice Remark Code. These would also not be appropriate for CARC codes. So a new list is needed for "Industry specific Remark Codes" that will welcome other industries needs for ISRC 's. "Industry specific Remark Codes" are codes needed in the respective industry that do not meet the criteria for CARC or RARC committees.
Location X322 | Health Care Claim Payment/Advice | 835 | 0350 | 2100
MOA - Outpatient Adjudication Information
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 0350 | 2100
MOA - Outpatient Adjudication Information
Action Modify Data Element Industry Name
Modify all Loop ID 2100/MOA segment Remark Code elements (MOA03 through MOA07) to Not Used. Remark Codes are now reported in either a RAS Segment (when associated with a CARC) or an LQ Segment.
CR 1234 There are industries that need very specific regulatory language for reasons that DO NOT fit into the criteria for the Remittance Advice Remark Code. These would also not be appropriate for CARC codes. So a new list is needed for "Industry specific Remark Codes" that will welcome other industries needs for ISRC 's. "Industry specific Remark Codes" are codes needed in the respective industry that do not meet the criteria for CARC or RARC committees.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400 | 2100
REF - Other Claim Related Identification
Action Modify Segment Situational Rule
Loop ID 2100 REF - Other Claim Related Information - Modify Segment Situational Rule to include additional situations when segment is required.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400 | 2100
REF - Other Claim Related Identification
Action Add Data Element Code Value
Loop ID 2100 / REF (Other Claim Related Information)

Add Data Element Code Values OX (Statement Number), M7 (Medical Assistance Category), 5N (Citation or Statute), and Y4 (Agency Claim Number) and notes.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400 | 2100
REF - Other Claim Related Identification
Action Delete Data Element Code Value
Loop ID 2100 REF - Other Claim Related Identification - Delete Data Element Code Values G1 and BB. These Code Values are moved to a new unique REF (Claim Authorization Information).
CR 1086 Clarify use of Authorization Numbers in the 835.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400 | 2100
REF - Other Claim Related Identification
Action Delete Data Element Code Value
G3 Predetermination of Benefits Identification Number
CR 1086 Clarify use of Authorization Numbers in the 835.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400 | 2100
REF - Other Claim Related Identification
Action Delete Data Element Code Value
SY Social Security Number
CR 1001 Need to revisit the Social Security Number qualifier in this REF as there is not way to determine who the SSN belongs to.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400 | 2100
REF - Other Claim Related Identification
Action Delete Data Element Code Value
1W - Member Identification Number
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400 | 2100
REF - Other Claim Related Identification
Action Delete Data Element Code Value
A6 - Provider Identifier
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400 | 2100
REF - Other Claim Related Identification
Action Delete Data Element Code Value
CE - Class of Contract Code
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400 | 2100
REF - Class of Contract Code
Action Add Segment
Add new unique REF segment (Class of Contract Code) as situational, with situational rule, qualifier CE and notes.
CR 1404 To enable identification of plan information for the payee on the 835
Location X322 | Health Care Claim Payment/Advice | 835 | 0400 | 2100
REF - Rendering Provider Secondary Identification
Action Modify Segment Name
Modify Segment Name to "Rendering Provider Secondary Identification", include code values LU and A6 with notes.
CR 1181 For consistency across TR3's, Recommend Changing the name of the Location Identification 2100 REF to Additional Rendering Provider Identification Number (Currently the Location Identification segment) include both the LU and A6 to carry the payer assigned identifiers; increase the repeat to '2'. The Code LU and A6 should be consistent with the notes in the claim. This would result in removing the 'SV' qualifier from the NM108 for Rendering Provider and change from required to situational - this is consistent with the way the 837.
Location X322 | Health Care Claim Payment/Advice | 835 | 0400 | 2100
REF - Payment Determination Methodology
Action Add Segment
Add Segment REF - Payment Determination Methodology as situational including situational rule, code values 1S, 9V, AFT, APC, and notes.
CR 1405 To allow the reporting of the methodology used to derive the allowed amount used for adjudication.
Location X322 | Health Care Claim Payment/Advice | 835 | 0500 | 2100
DTM - Statement Dates
Action Modify Segment Name
Statement Dates
CR 1185 For consistency across TR3s, The Segment Name and Situational Rule on the DTM should be the Statement From AND To Date vs. From OR To since both dates are allowed. This segment needs to be aligned with the claim - professional claim has service dates only at the service level and the institutional has statement date only at the claim level. Use the same qualifiers and elements so that payers can return what is received in the claim.

The Situational Note needs to be modified to "Required when the "Service Date" is not supplied in 2100 DTM..." to align with the name of the Segment. If the above request is implemented then this note should align with the new name.
Location X322 | Health Care Claim Payment/Advice | 835 | 0500 | 2100
DTM - Statement Dates
Action Modify Segment Situational Rule
Loop ID 2100 DTM Statement Dates Update Segment Situational Rule to include exclusion of Predetermination Claims.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0500 | 2100
DTM - Statement Dates
Action Modify Segment Note
Loop ID 2100 DTM Statement Dates - Modify Segment Note for Predetermination Claims to remove requirement for default date. No dates are sent for Predetermination Claims.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0500 | 2100
DTM - Coverage Expiration Date
Action Modify Segment Situational Rule
Loop ID 2100 DTM Coverage Expiration Date - Modify Segment Situational Rule to include relationship with real-time adjudication.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0500 | 2100
DTM - Claim Received Date
Action Modify Segment Situational Rule
Loop ID 2100 DTM Claim Received Date - Modify Segment Situational Rule to include pharmacy requirements.
CR 649 Revise the Claim Received Date DTM Segment situational rule to require it when state or federal regulations or the provider contract mandate interest or prompt payment discounts based upon claim receipt date or clean claim date.
Location X322 | Health Care Claim Payment/Advice | 835 | 0500 | 2100
DTM - Clean Claim Date
Action Add Segment
Add Segment Loop ID 2100 DTM (Clean Claim Date) as Situational, with Situational Rule and notes
CR 649 Revise the Claim Received Date DTM Segment situational rule to require it when state or federal regulations or the provider contract mandate interest or prompt payment discounts based upon claim receipt date or clean claim date.
Location X322 | Health Care Claim Payment/Advice | 835 | 0500 | 2100
DTM - Corrected Accident Date
Action Add Segment
Add Segment Loop ID 2100 DTM (Corrected Accident Date) as Situational, with Situational Rule and notes.
CR 661 Add information for Accident Date, including the date the mishap occurred.
Location X322 | Health Care Claim Payment/Advice | 835 | 0500 | 2100
DTM - Corrected Onset of Current Symptoms or Illness Date
Action Add Segment
Add Segment Loop ID 2100 DTM (Corrected Onset of Current Symptoms or Illness Date) as Situational, with Situational Rule and notes.
CR 660 Add information for Onset of Current Symptoms or Illness, including corrected date of onset of current symptoms or illness.
Location X322 | Health Care Claim Payment/Advice | 835 | 0600 | 2100
PER - Claim Contact Information
Action Modify Segment Situational Rule
Loop ID 2100 PER Claim Contact Information - Modify Segment Situational Rule to exclude pharmacy
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0600 | 2100
PER - Claim Contact Information
Action Modify Data Element Situational Rule
PER06 - Modify Data Element Situational Rule to include relationship with PER05.
CR 1154 For consistency across all TR3s.
Location X322 | Health Care Claim Payment/Advice | 835 | 0600 | 2100
PER - Entity Self-Insured Plan / Jurisdiction Contact
Action Add Segment
Add Segment Loop ID 2100 PER - Entity Self-Insured Plan / Jurisdictional Contact as situational, with situational rule and notes.
CR 1498 The term "self-insured" is used in various places throughout the TR3, but is spelled inconsistently, sometimes capitalized, sometimes with a hyphen, other times without. Need to make this term consistent throughout the TR3.
Location X322 | Health Care Claim Payment/Advice | 835 | 0600 | 2100
PER - Entity Self-Insured Plan / Jurisdiction Contact
Action Modify Data Element Situational Rule
PER06 - Modify Data Element Situational Rule to include relationship with PER05.
CR 1154 For consistency across all TR3s.
Location X322 | Health Care Claim Payment/Advice | 835 | 0600 | 2100
PER - Workers' Compensation Payer Website
Action Add Segment
Add Segment Loop ID 2100 PER - Worker's Compensation Payer Website as situational, with situational rule and notes.
CR 1138 Payers have different levels of security. There is a need to direct providers to the best location needed to supply information, which sometimes may be within a secure site.
Location X322 | Health Care Claim Payment/Advice | 835 | 0600 | 2100
PER - Workers' Compensation Payer Website
Action Modify Data Element Situational Rule
PER06 - Modify Data Element Situational Rule to include relationship with PER05.
CR 1154 For consistency across all TR3s.
Location X322 | Health Care Claim Payment/Advice | 835 | 0620 | 2100
AMT - Claim Supplemental Information
Action Modify Segment Repeat
changed from 13 to 12.
CR 1205 Modify repeat count to coincide with the available number of qualifiers.
Location X322 | Health Care Claim Payment/Advice | 835 | 0620 | 2100
AMT - Claim Supplemental Information
Action Add Segment Note
"Supplemental information reported at the Service level (2110 loop) AMT Segment are not repeated at the claim level (2100 loop) AMT Segment."
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0620 | 2100
AMT - Claim Supplemental Information
Action Delete Data Element Code Value
T2 Total Claim Before Taxes
CR 1139 It is unclear what should go into the AMT*T2 money amount field, whether the original amount or adjudicated amount. Based on the confusion that exists in the industry between use of the T qualifier vs T2 qualifier (and the fact that no one seems to be using T2), it was determined the best solution is to remove T2 to eliminate confusion.
Location X322 | Health Care Claim Payment/Advice | 835 | 0620 | 2100
AMT - Claim Supplemental Information
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 0660 | 2100
LQ - Health Care Remark Codes
Action Add Segment
Loop ID 2100 LQ Segment -Health Care Remark Codes

Add new Segment as Situational, with Situational Rule and Notes. This new segment will convey all remark codes that are not associated with a specific CARC appearing in a RAS segment.
CR 1234 There are industries that need very specific regulatory language for reasons that DO NOT fit into the criteria for the Remittance Advice Remark Code. These would also not be appropriate for CARC codes. So a new list is needed for "Industry specific Remark Codes" that will welcome other industries needs for ISRC 's. "Industry specific Remark Codes" are codes needed in the respective industry that do not meet the criteria for CARC or RARC committees.
Location X322 | Health Care Claim Payment/Advice | 835 | 0670 | 2105
N1 - Corrected Priority Payer Name
Action Add Segment
New Loop 2105, N1 - Corrected Priority Payer Name Segment

Situational Rule: Required when the current payer believes that another payer has priority for making a payment and the claim is not being automatically transferred to that payer. If not required by this implementation guide, do not send.
CR 1043 Need to report the Crossover NM1 segment with multiple occurrences. Also need to report more Corrected Priority Payers.
Location X322 | Health Care Claim Payment/Advice | 835 | 0675 | 2105
NM1 - Other Subscriber Name
Action Add Segment
New Loop 2105, NM1 - Other Subscriber Name

Situational Rule: Required when a corrected priority payer has been identified in this iteration of Loop 2105 N1 Corrected Priority Payer Name Segment AND the name or ID of the other subscriber for this payer is known. If not required by this implementation guide, do not send.
CR 1043 Need to report the Crossover NM1 segment with multiple occurrences. Also need to report more Corrected Priority Payers.
Location X322 | Health Care Claim Payment/Advice | 835 | 0700 | 2110
SVC - Service Payment Information
Action Add Data Element Note
SVC06-02 through SVC06-06 and SVC06-09 through SVC06-12 are intended to convey the originally submitted service, and are not intended to be validated when the qualifier in SVC06-01 is RA.
CR 685 Clarify what should be reported in SVC01 and SVC06 when invalid procedure / service codes come in on the claim (e.g. paper). How should the original bad code be reported in the 835 to show what came in versus what was adjudicated?
Location X322 | Health Care Claim Payment/Advice | 835 | 0700 | 2110
SVC - Service Payment Information
Action Add Data Element Note
SVC01-02 through SVC01-06 and SVC01-09 through SVC01-12 are intended to convey the adjudicated service, and are not intended to be validated when the qualifier in SVC01-01 is RA.
CR 685 Clarify what should be reported in SVC01 and SVC06 when invalid procedure / service codes come in on the claim (e.g. paper). How should the original bad code be reported in the 835 to show what came in versus what was adjudicated?
Location X322 | Health Care Claim Payment/Advice | 835 | 0700 | 2110
SVC - Service Payment Information
Action Modify Segment Situational Rule
Loop 2110 SVC update Situational Rule to clearly identify when SVC required
CR 1449 RFI 1950 and others have requested clarification on the situational rule associated with the 2110 SVC segment in the 835. Because we continue to receive requests for clarification on when the SVC segment is required, we need to reword the situational rule to make it clear when the segment is required.
Location X322 | Health Care Claim Payment/Advice | 835 | 0700 | 2110
SVC - Service Payment Information
Action Add Data Element Code Value
Loop ID 2110 SVC01-01 Add new Data Element Code Value RA (Return Code) for use when an invalid code was submitted on the claim and used for adjudication. This would acknowledge that the code indicated was invalid and can't be validated.
CR 685 Clarify what should be reported in SVC01 and SVC06 when invalid procedure / service codes come in on the claim (e.g. paper). How should the original bad code be reported in the 835 to show what came in versus what was adjudicated?
Location X322 | Health Care Claim Payment/Advice | 835 | 0700 | 2110
SVC - Service Payment Information
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 0700 | 2110
SVC - Service Payment Information
Action Modify Data Element Situational Rule
Loop ID 2110 SVC (Service Payment Information) SVC06 (Submitted Procedure Code Information) - Update Situational Rule to include requirement for reporting for differences in modifiers in addition to procedure code.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0700 | 2110
SVC - Service Payment Information
Action Add Data Element Code Value
Loop ID 2110 SVC06-01 Add new Data Element Code Value RA (Return Code) for use when an invalid code was submitted on the claim and used for adjudication. This would acknowledge that the code indicated was invalid and can't be validated.
CR 685 Clarify what should be reported in SVC01 and SVC06 when invalid procedure / service codes come in on the claim (e.g. paper). How should the original bad code be reported in the 835 to show what came in versus what was adjudicated?
Location X322 | Health Care Claim Payment/Advice | 835 | 0700 | 2110
SVC - Service Payment Information
Action Delete Data Element Code Value
IV - Home Infusion EDI Coalition (HIEC) Product/Service Code
CR 1379 For consistency across all guides.
Location X322 | Health Care Claim Payment/Advice | 835 | 0800 | 2110
DTM - Service Date
Action Modify Segment Note
Loop ID 2100 DTM Statement Dates - Modify Segment Note for Predetermination Claims to remove requirement for default date. No dates are sent for Predetermination Claims.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0950 | 2110
RAS - Service Adjustment Information
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 0950 | 2110
RAS - Service Adjustment Information
Action Add Data Element Code Value
Loop ID 2110/RAS03-02 (Code List Qualifier Code)

RM - Insurance Industry Specific Remark Codes

New external code list to provide remark codes not in the Remittance Advice Remark Code list.
CR 1234 There are industries that need very specific regulatory language for reasons that DO NOT fit into the criteria for the Remittance Advice Remark Code. These would also not be appropriate for CARC codes. So a new list is needed for "Industry specific Remark Codes" that will welcome other industries needs for ISRC 's. "Industry specific Remark Codes" are codes needed in the respective industry that do not meet the criteria for CARC or RARC committees.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Service Identification
Action Modify Segment Repeat
Loop ID 2110 REF Service Identification - Modify Segment Repeat from 8 to 4.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Service Identification
Action Modify Segment Situational Rule
Loop ID 2110 REF Service Identification - Modify Segment Situational Rule to clarify requirements for not only use in the service line adjudication, but also as a result of the service line adjudication.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Service Identification
Action Modify Data Element Code Value
Loop ID 2110 REF (Service Identification) Update Code Values to include only E9 and LU. Other code values removed.
CR 1379 For consistency across all guides.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Service Identification
Action Delete Data Element Code Value
Loop ID 2110 REF Service Identification - Delete Data Element Code Values G1 and BB, these codes moved to new unique REF - Service Authorization Number
CR 1086 Clarify use of Authorization Numbers in the 835.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Service Identification
Action Add Data Element Code Note
E9 - Attachment Code

Use when an Attachment Control Number was assigned by the provider.
CR 1085 REF01 - Service Identification.
Provide usage for the code values of E9 Adjustment Code and G3 Predetermination of Benefits Identification Number.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Service Identification
Action Delete Data Element Code Value
G3 Predetermination of Benefits Identification Number
CR 1086 Clarify use of Authorization Numbers in the 835.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Service Identification
Action Delete Data Element Code Value
1S - Ambulatory Patient Group (APG) Number
CR 1379 For consistency across all guides.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Service Identification
Action Delete Data Element Code Value
RB - Rate code number
CR 1379 For consistency across all guides.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Service Identification
Action Delete Data Element Code Value
APC - Ambulatory Payment Classification
CR 1379 For consistency across all guides.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Service Identification
Action Delete Data Element Code Value
BB - Authorization Number
CR 1379 For consistency across all guides.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Payment Determination Methodology
Action Add Segment
Add Segment Loop ID 2110 REF - Payment Determination Methodology as situational, with situational rule, qualifiers, and code notes.
CR 1086 Clarify use of Authorization Numbers in the 835.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - Rendering Provider Information
Action Modify Data Element Code Value
Loop ID 2110 REF (Rendering Provider Information) - Modify Code Values to include only A6 and HPI with notes. Remove payer-specific code values.
CR 1379 For consistency across all guides.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - HealthCare Policy Identification
Action Add Segment Note
Loop ID 2110 REF Healthcare Policy Identification - Add Segment Note regarding procedure to use during reversals.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 1000 | 2110
REF - HealthCare Policy Identification
Action Modify Segment Note
Loop iD 2110 REF Healthcare Policy Identification - Modify Segment Note to clarify relationship with PER segments.
CR 1138 Payers have different levels of security. There is a need to direct providers to the best location needed to supply information, which sometimes may be within a secure site.
Location X322 | Health Care Claim Payment/Advice | 835 | 1100 | 2110
AMT - Service Supplemental Amount
Action Add Segment Note
Loop ID 2110 AMT Service Supplemental Amount - Add Segment Note clarifying that amounts reported at the claim level are not repeated at the service level.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 1100 | 2110
AMT - Service Supplemental Amount
Action Delete Data Element Code Value
T2 Total Claim Before Taxes
CR 1139 It is unclear what should go into the AMT*T2 money amount field, whether the original amount or adjudicated amount. Based on the confusion that exists in the industry between use of the T qualifier vs T2 qualifier (and the fact that no one seems to be using T2), it was determined the best solution is to remove T2 to eliminate confusion.
Location X322 | Health Care Claim Payment/Advice | 835 | 1100 | 2110
AMT - Service Supplemental Amount
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 1200 | 2110
QTY - Service Supplemental Quantity
Action Modify Segment Repeat
Loop ID 2110 QTY Service Supplemental Quantity - Modify Segment Repeat from 6 to 5.
CR 1154 For consistency across all TR3s.
Location X322 | Health Care Claim Payment/Advice | 835 | 1300 | 2110
LQ - Health Care Remark Codes
Action Add Data Element Code Value
Loop ID 2110/LQ01 (Code List Qualifier Code)

RM - Insurance Industry Specific Remark Codes

Update LQ to include use of new external code list for Insurance Industry Specific Remark Codes
CR 1234 There are industries that need very specific regulatory language for reasons that DO NOT fit into the criteria for the Remittance Advice Remark Code. These would also not be appropriate for CARC codes. So a new list is needed for "Industry specific Remark Codes" that will welcome other industries needs for ISRC 's. "Industry specific Remark Codes" are codes needed in the respective industry that do not meet the criteria for CARC or RARC committees.
Location X322 | Health Care Claim Payment/Advice | 835 | 1400 | 2110
TOO - Tooth Information
Action Add Segment
Add Segment Loop ID 2110 TOO Segment (Tooth Information) as situational, with situational rule, code values, and notes.
CR 1040 DM was process and is available for next version.
The TOO segment should be added to the 835 for the purpose of a dental payment indicating the tooth number and surface that was adjudicated.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100
PLB - Provider Adjustment
Action Modify Data Element Note
Modify Data Element PLB03-01 to use external code list for Provider Adjustment Codes
CR 1039 835 - Make Provider Adjustment Codes an external list as there are situations where additional Claim Adjustment Group Codes are needed to meet changing business or regulatory requirements. Making this list external will allow more flexibility in meeting those needs.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100
PLB - Provider Adjustment
Action Modify Data Element Note
Modify Data Element note PLB03-02 to clarify use of Reference Identifier.
CR 1153 To clarify intended use.
Location X322 | Health Care Claim Payment/Advice | 835 | 0100
PLB - Provider Adjustment
Action Add Data Element Note
Multiple Loops / Multiple Data Elements

Data Element 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013 Add a consistent element note explaining the maximum length to every monetary amount element.
Location X322 | Health Care Claim Payment/Advice | 835 | 0200
SE - Transaction Set Trailer
Action Modify Data Element Note
Transaction Set Trailer, Data Element SE02 (Transaction Set Control Number)

Changed to "The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). For example, start with the number 0001 and increment from there. The number also aids in error resolution research."
CR 999 Revise the ST02 notes across the TR3's to make them consistent.