Work Group 2 - Remittance
Work Group 2 - Remittance (WG2 Remittance)
Through a consensus building process, this work group is responsible for advancing the adoption of electronic remittance primarily through the creation of best practice guidelines for the ANSI ASC X12 835D transactions.
Expedited remittance information and faster payment are key benefits of using an electronic version of an Explanation of Benefits (EOB) document. The ASC X12 835 Claim Payment /Advice transaction enables dental providers and payers to exchange enhanced EOB information electronically. This includes information on charges experienced during a patient encounter, amount the payer is remitting to the provider, contractual adjustments, and any reasons the charges might have been denied.
The ASC X12 835 was developed for use in healthcare overall. NDEDIC is working to make the ASC X12 835 optimally useful for the dental industry, thereby also increasing adoption.
Orthodontic Claim Remittance Best Practices Guide
The work group has finalized the development of a guidance document for the ASC X12 835 transaction for a unique business scenario. Dental providers of orthodontia services often submit one claim and dental payers remit payment to the provider over time.
Today, the remittance reporting does not adequately inform the practice of the time frame and frequency of the deferred payments, along with details of the patient and plan’s financial responsibilities. This guide provides detailed recommendations for a wide array of calculations the dental payer performs and how this maps to the ASC X12 835 transaction. This guide is currently available for free to NDEDIC members on the Member Portal and available for purchase on the upper righthand side of this page for non-members.
Best Practices Guide for the Use of CARCs and RARCs
NDEDIC’s Remittance Work Group develops best practice guidelines for implementing the ASC X12 835 in dental claims processing promoting the consistent use of Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs). Inconsistent use of the CARCs and RARCs by payers can hamper use of the electronic transaction by dental offices.
The NDEDIC work group is soliciting input from the dental industry to identify an inclusive list of current dental Explanation of Benefits (EOB) messages and the CARCs and RARCs that best map to those messages. The goal is to develop a standardized mapping process.
If there are cases where existing CARCs and RARCs lists do not meet dental EOB needs, the work group will facilitate the process of requesting new codes and develop a Best Practices Guide for the Use of CARCs and RARCs. National committees review the codes regularly and Washington Publishing Company publishes updated code lists three times a year.
The work group will continue to update Best Practice Usage Guidelines for use of the ASC X12 835 in dental claims processing and collaborate with ASC X12 on recommended changes.