clm104c22.pdf

The CAQH CORE mandated operating rules establish standards for the enrollment of providers to ERA programs.  The rule mandates the required data elements and the order in which they appear on the ERA enrollment forms.  The rule also mandates acceptable EFT enrollment submission formats.   A comp lete list of required data elements and submission formats are available at http://www.caqh.org/Host/CORE/EFT -ERA/ERA_Enrollment_Data_Rule.pdf   Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R11427CP  05/20/2022  Claims Processing Manual Update -  Pub. 100.04 for Elimi nation of Certificates of Medical Necessity (CMNs) and Durable Medical Equipment Forms (DIFs)  01/03/2023  12734  R11414CP  05/12/2022  Claims Processing Manual Update -  Pub. 100.04 for  Elimination of Certificates of Medical Necessity (CMNs) and Durable Medical Equipment Forms (DIFs)  - Rescinded and replaced by Transmittal 11427 06/13/2022  12734  R10236CP   07/31/2020  Update to the IOM Publication (Pub) 100-04, Medicare Claims Processing Manual, Chapters 1, 6, 8, 17, 20, 22, 24, and 31 Referencing the Active Universal Resource Locators (URLs) for the Washington Publishing Company (WPC) and the ASC X12 Organizations, and Update s to the HIPAA Eligibility Transaction System (HETS)  08/31/2020  11857  R4388CP  09/06/ 2019  Manual Updates to Chapters 1, 22, 24, 26, and 31 in Publication (Pub.) 100- 04 10/07/ 2019  11331  R3288CP  07/02/2015  Medicare Internet Only Manual Publication 100-04 Chapter 22 Remittance Advice  08/03/2015  9199 R2843CP  12/27/2013  Medicare Claims Processing Pub. 100- 04, Chapter 22 Update  01/28/2014  8513 R2594CP  11/16/2012  Testing HIPPA Transactions Following a System Change  04/01/2013  8094 R2213CP  05/06/2011  Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update  07/05/2011  7369 R2205CP  04/29/2011  IOM 100 -04 Chapter 22 Update for Remittance Advice for Version 5010- ASC X12N 0050A1 and Related Standard Paper Remittance (SPR)  05/31/2011  7308 Rev #  Issue Date  Subject  Impl Date  CR#  R2194CP  04/22/2011  Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update  Rescinded and replaced by Transmittal 2213  07/05/2011  7369 R1385CP  11/30/2007  Shared System Participation in Claim Adjustment Reason Code and Remitta nce Advice Remark Code Maintenance  04/07/2008  5806 R1343CP  09/21/2007  Stage 3 NPI Changes for Transaction 835 and Standard Paper Remittance Advice  07/02/2007  5452 R1241CP  05/18/2007  Stage 3 NPI Changes for Transaction 835 and Standard Paper Remittance Advice -  Replaced by Transmittal 1343  07/02/2007  5452 R1063CP  09/22/2006  Ending the Contingency Plan for Remittance Advice and Charging for PC Print, Medicare Remit Easy Print, and Duplicate Remittance Advice  10/23/2006  5308 R1033CP  08/18/2006  Revise Chapters 22 and 24 to delete references to free downloads of X12 implementation guides adopted as HIPAA standards from Washington Publishing Company (WPC)  11/20/2006  5247 R996CP  06/30/2006  Stage 2 NPI Changes for Transaction 835, and Standard Paper Remittance Advice, and Changes in Medicare Claims Processing Manual, Chapter 22 -  Remittance Advice -  Replaces Rev. 948  10/02/2006  5081 R948CP  05/12/2006  Stage 2 NPI Changes for Transaction 835, and Standard Paper Remittance Advice, and Changes in Medicare Claims Processing Manual, Chapter 22 -  Remittance Advice  10/02/2006  5081 R885CP  03/10/2006  Suppression of Standard Paper Remittance Advice to Providers and Suppliers Also Receiving Electronic Remittance Advice for 45 Days or Mor e. 06/01/2006  4376 R555CP  05/02/2005  Fiscal Intermediary (FI) Reporting of Add-on Payments that Do Not Result in a 10/03/2005  3866 Rev #  Issue Date  Subject  Impl Date  CR#  Specific Increase or Decrease in the Amount Reported as Payable for a Claim or a Service on a Remittance Advice.  R252CP  07/23/2004  Expansion of paper remittance advice to accommodate forced balanced amount, corresponding change in the flat file, and a change in the companion document for fiscal intermediaries (FIs) and their shared system maintainer (SSM)  01/03/2005  3344 R001CP  10/01/2003  Initial Publication of Manual  NA NA Back to top of chapter