Providers continue to question the explanation of the codes shown on their claim confirmation report, as well as their remittance advices.
MO HealthNet no longer reports MO HealthNet-specific explanation of benefits and exception message codes on any type of remittance advice. As required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) national standards, administrative code sets, such as Claim Adjustment Reason Codes, Remittance Advice Remark Codes, and NCPDP Version 5.0 Reject Codes for Telecommunication Standard are used.
Explanations for claim status codes, remittance advice remark codes and claim adjustment reason codes can be found on the Internet at Washington Publishing Company under the HIPAA-Related Code Lists. A listing of the NCPDP Version 5.0 Reject Codes for Telecommunication Standard can be found in the NCPDP Version 5.Ø Reject Codes For Telecommunication Standard appendix.
More information on HIPAA-Related Code Lists can be referenced in Section 17 (Claims Disposition) of your provider manuals.