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Industry Specific Remark Codes

X12 External Code Source 973

These codes convey information about remittance processing or further explain an adjustment already described by a Claim Adjustment Reason Code (CARC) from ECL 139.

Last updated: 7/1/2020

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The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses:

  1. Received
    The request has been submitted but is not yet under review.
  2. Triaged
    Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
  3. In Process
    The CMG has initiated their decision process.
  4. On Hold
    The CMG has initiated their decision process but cannot complete it at this time.
  5. CMG Approved
    The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
  6. CMG Disapproved
    The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.
Num. Date Requested Description Type Code Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.
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Use the form below to request maintenance to the Code List. Maintenance includes a request for a new code, a revision to the description of code, or deactivation of a code.

Note
The information submitted on this form may be edited for clarity or accuracy during the X12 triage and consideration processes.

Fields marked with an asterisk are required. Existing Code is required on requests for revision or deactivation of a code.

* Name
* Phone
* Email
* Request Type
Existing Code

* Brief description, published with the Code

Extended description, published with the Code

* Include the business justification for this maintenance request here, including who would benefit and the circumstances that make the request appropriate or necessary.

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01 The injured employee or other party has not signed the required attestation document therefore Florida Statute 440.105(7) requires that benefits and payments be suspended until such signature is obtained.
Start: 06/01/2020
02 Coverage based on a property and casualty Excess Insurance policy which is governed by state statute or regulation.
Start: 06/01/2020
03 Reimbursement based on the treating hospital's designation as a lien hospital with billing precedence.
Start: 06/01/2020
04 Reimbursement based on state-specific Workers' Compensation requirements for timely submission of bills for services rendered.
Start: 06/01/2020
05 Reimbursement based on a state-specific Workers' Compensation limitation that the procedure code be billed only once, regardless of the number of limbs tested.
Start: 06/01/2020
06 The provider's preliminary notice of injury and treatment was not furnished by the close of the third business day following the first treatment in accordance with Florida Statute Section 440.13(4)(a), therefore this claim is not considered valid.
Start: 06/01/2020