The most up-to-date, complete lists of denial codes used in the adjudication of Medicare claims are maintained by Washington Publishing Company and available at WPC-EDI.com/reference, according to Noridian Healthcare Solutions. The lists include the Claim Adjustment Reason Codes and the Remittance Advice Remark Codes.
Medicare claims are transmitted through an electronic data interchange using the Accredited Standards Committee X12N standards that were adopted as the national standard under the Health Insurance Portability and Accountability Act, notes the Centers for Medicare and Medicaid Services. After the Medicare contractor processes the bill for services submitted by the health care provider, an accounting of payments made, as well as payments not made, is sent to the provider. Claim Adjustment Reason Codes, a set of standardized alphanumeric codes, are used to explain why the claim or a particular service line was either paid in a different amount than was billed or was not paid at all. Remittance Advice Remark Codes may be used to provide supplemental explanation for the financial adjustments that were made.
The code lists are maintained by the Centers for Medicare and Medicaid Services, the National Uniform Claim Committee and committees that meet during regular X12 meetings, reports Washington Publishing Company. The lists of codes are updated tri-annually in March, July and November.