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October 2013

Benefit maximums will be more accurately reported in 835 remittance files

Starting November 2013, we will distribute enhanced NASCO 835 electronic remittance advice transactions.

The enhancements to the NASCO 835 files will make it easier to identify a member’s liability amount when his or her benefit maximum has been exceeded. Professional and Institutional 835s will now report the liability amount in Loop 2100 or Loop 2110 CAS segments:

How  a CAS segment
looks today

How a CAS segment will look as of November

CAS*PI*119
(PI = Payer initiated)

CAS*PR*119
(PR = Patient responsibility)

To assist with patient account reconciliation, members’ explanation of benefits will also include a line that identifies the benefit excess. Members will be responsible for paying the excess to the provider.

If you have questions regarding this information, please call the Electronic Data Interchange Help Desk at 1-800-542-0945.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
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