CRX.002.035

CLAIM-PYMT-REM-CODE-1

Data Element

DE Number

CRX035

System DE Number

CRX.002.035

File Name

CRX - CLAIM PHARMACY

File Segment Number

CRX00002

File Segment Name

CLAIM-HEADER-RECORD-RX

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	208
FLF Stop Position	212
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

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
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RULE ID	RULE Definition
RULE-1776	If the claim payment rem code 1 is populated on a non-denied claim from an RX file, then the claim payment rem code 1 reported must be found in the list of valid values.
RULE-1777	If more than one CLAIM-PYMT-REM-CODE is submitted on a non-denied RX claim, then the values must be unique.
RULE-6780	If a claim line is a non-denied claim line from an RX file, then the claim payment REM code 1 value reported must be compatible with specified T-MSIS picture format: X(5).

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Measure ID	Measure Name
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DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP108	CIP.002.108	CLAIM-PYMT-REM-CODE-1	CIP00002	CLAIM-HEADER-RECORD-IP
CLT059	CLT.002.059	CLAIM-PYMT-REM-CODE-1	CLT00002	CLAIM-HEADER-RECORD-LT
COT044	COT.002.044	CLAIM-PYMT-REM-CODE-1	COT00002	CLAIM-HEADER-RECORD-OT