News Flash

New 835 Improvements for Maryland CARE Institutional Claims

CareFirst has made improvements to the 835 electronic remittance for Maryland-based institutional claims that are processed on the CARE system. This improvement will apply to institutional claims where Medicare has made a primary payment, CareFirst is processing as secondary, and CareFirst is rejecting the entire claim.

CareFirst will:

• Report the Medicare primary payment with Claim Adjustment Group code ‘CO’ in the CAS01 field.
• Report the balance remaining after the Medicare payment with the Claim Adjustment Group code that is appropriate for the rejection. This Claim Adjustment Group code will be either ‘CO’, ‘PR’, or ‘PI’.

What this means to you:

• The CAS segments contain monetary amounts and codes that define the amounts.
• You will be able to more accurately identify contractual obligation and patient responsibility.

Prior to this improvement, CareFirst reported the entire billed charge with the Claim Adjustment Group code that is appropriate for the rejection. The Medicare primary payment was not carved out as a separate amount. The first remittances have a check date of January 15, 2008.

CareFirst is working on several other improvements to the 835 electronic remittance. We will post additional announcements as each release date approaches.