We're making changes to our remittance advice (RA) and explanation of benefit (EOB) codes for commercial and Medicare APC claims effective Nov.  1, 2019

We're updating our remittance advice language on our commercial and Medicare ambulatory payment classification (APC) claims. This change will affect the claim adjustment group code and how its represented.

What is a claim adjustment group code?

A claim adjustment group code consists of two alpha characters that assign the responsibility of a claim adjustment on the EOB. For example, OA or CO.

What’s changing?

Providers may see a change in how claim adjustment reason code 97 is represented in the electronic remittance advice (835 file). In some instances, OA*97 may now be reported as CO*97 and OA*94 may no longer be reported.

What do I need to do? 

Update your system as needed, and if you have any questions, contact provider.services@priorityhealth.com