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Code Value Usage in Health Care Claim Payments and Subsequent Claims 005010/006020

The Code Value Usage in Health Care Claim Payments and Subsequent Claims Technical Report 2 presents code usage rules for three code sets used in the Health Care Claim Payment/Advice (835). These code sets are: Claim Adjustment Group Codes, published in X12 Health Care Claim Payment/Advice (835) Technical Report Type 3 (005010X221 and errata 005010X221A1); Claim Adjustment Reason Codes (CARCs); Remittance Advice Remark Codes (RARCs). The TR2 was developed to foster standard code use by presenting the valid combinations of these code sets. These usage rules may be applied to 005010 and 006020 versions of the 835 TR3 but are not mandated for use at this time.


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