Remittance voucher and claim adj reason codes

Remittance Voucher

Each time payment is made to a provider Medicaid sends a paper or electronic remittance voucher (RV) listing the status of any claims Medicaid has paid, denied or pended. This section discusses the paper RV.
In the far right column of the RV is a three-digit code. This code is the Claim Adjustment Reason Code that explains Medicaid’s reason for denying or pending a claim payment.

In some instances there will also be a Remark Code with the Claim Adjustment Reason Code. The Remark Code communicates specific information about the claim. On the last page of each RV is a summary section that translates the codes into narrative form.

Claim Adjustment Reason Codes

Claim adjustment reason codes communicate why a claim or claim line was denied or paid differently than it was billed. If there is no denial or adjustment to a claim or claim line, then there is no adjustment reason code.

Medicaid uses the ASC (American Standard Committee) X12 Claim Adjustment reason codes required by HIPAA to communicate claim or claim line denials or adjustments.

 For a list of Claim Adjustment Reason Codes.

Remark Codes

Remark codes are used to communicate additional information about the denial or adjustment of a claim or claim line that cannot be thoroughly explained by a Claim Adjustment Reason Code.

Medicaid uses the standard HIPAA Remark codes that are maintained by the Centers for Medicare and Medicaid Services (CMS) to communicate additional information about claim or claim line denials or adjustments.

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