CIP.002.111

CLAIM-PYMT-REM-CODE-4

Data Element

DE Number

CIP111

System DE Number

CIP.002.111

File Name

CIP - CLAIM INPATIENT

File Segment Number

CIP00002

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message as shown in the Remittance Advice Remark Code List. It is a code set used by the health care industry to convey non-financial information critical to understanding the adjudication of a health care claim for payment. It is an external code set whose use is as mandated by the Administrative Simplification provisions of the Health Insurance Portability and Accountably Act of 1996 (P.L.104-191, commonly referred to as HIPAA).
Size	X(5)
FLF Start Position	502
FLF Stop Position	506
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Claim Payment Remittance Code List (VVL) 2. Value must be 5 characters or less 3. Conditional 4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique 5. Value must not be populated when Remittance Advice Remark Code 3 (CIP.002.110) is not populated

This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version.

Claim Payment Remittance Code List

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-521	If at least two of the 4 claim payment remark codes are populated on a non-denied, non-void claim from an IP file, then the claim payment remark code values reported must be unique values.
RULE-528	If the claim payment rem code 4 is populated on a non-denied claim from an IP file, then the claim payment rem code 4 reported must be found in the list of valid values.
RULE-530	If a non-denied IP claim does not have a value populated for the claim payment rem code 3, then the claim does not have a value populated for claim payment rem code 4.
RULE-7040	If a claim line is a non-denied claim line from an IP file, then the claim payment REM code 4 value reported must be compatible with specified T-MSIS picture format: X(5).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT062	CLT.002.062	CLAIM-PYMT-REM-CODE-4	CLT00002	CLAIM-HEADER-RECORD-LT
COT047	COT.002.047	CLAIM-PYMT-REM-CODE-4	COT00002	CLAIM-HEADER-RECORD-OT
CRX038	CRX.002.038	CLAIM-PYMT-REM-CODE-4	CRX00002	CLAIM-HEADER-RECORD-RX