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04-Nov-2019 12:18

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The TRN Segment in the Addenda Record of the CCD Addenda should be the same as the TRN Segment in the associated ERA that describes the payment.Using the same TRN Segment helps to match the payment to the correct remittance advice, a process called reassociation.Healthcare reimbursement costs are rising, while insurance premiums are under downward pressure from highly competitive marketplace exchanges and high deductible health plans.

In the complex world of insurance claims payments, insurers and third-party administrators across the U. are seeking new ways to gain efficiencies and savings in their processes.The adapted set of rules standardizes healthcare EFTs, which is critical to the healthcare industry’s payments operation.This collaboration between Nacha and the healthcare industry came about as a result of the Patient Protection and Affordable Care Act (ACA), which mandated identification of a healthcare EFT standard and the implementation of operating rules for all electronic healthcare transactions by January 1, 2014.Under HIPAA, all health plans, including Medicare, are required to use claims adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) instead of property codes, to explain any adjustment in the claim payment.

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X12 is the recognized code set maintainer for the CARCs and RARCs.To find resources to support adoption and implementation of the Healthcare EFT Standard and ERA, visit the Healthcare Resource Center.



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