Electronic Remittance Advice (835) Request Form With the move to being Health Insurance Portability Assurance Act (HIPAA) compliant, Humana has made available the HIPAA X12N 835 version 4010 A1 electronic remittance advice (ERA). The electronic format may be accessed in the following ways:

Via a clearinghouse

The clearinghouse method enables providers, vendors, or billing services to receive an 835 Electronic Remittance Advice file from selected commercial clearinghouses. They can receive these files directly from Availity (Humana’s central gateway for electronic data exchange transactions) or from their clearinghouse via Availity. The 835 health care ERA will replace the current paper remittance report.

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835 Healthcare Electronic Remittance Advice Request Form with General Completion Instructions
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Explore the Provider Self-Service Center

The online remit inquiry is a self-service application that enables providers to view remittance information online via the secured provider section of Humana.com. The function offers several different inquiry methods and the ability to customize the viewing of the data with the use of filters and sorts. Providers can also download the HIPAA X12N 835 version 4010 A1 electronic remittance advice remittance in a format (text or Word document) or as a remittance inquiry supplement file (Excel spreadsheet)

If you are not a current user of the secured provider section, please register.

Once you have access to the secured provider section of Humana.com, you can immediately access the online remit inquiry function to inquire about paid claims.

Remittance Advise Remark Codes (RARCs)

HIPAA has mandated that the ANSI X12N 835 Health Care Claim Payment/Advice include Remittance Advise Remark Codes (RARCs). RARCs provide greater clarity of how claims have been adjudicated by adding a subset of descriptions to the generic, high level, Claims Adjustment Reason Codes (CARCs). Humana has revised its mapping of our proprietary coding that correlates to the mandated RARCs. Humana has assigned multiple RARCs to a CARC so that providers receive more adjudication detail concerning their claims. Humana has completed its mapping and is generating RARCs beginning July 13, 2008.

The RARCs appear in the LQ02 segment in Loop 2110 of the X12N 835. The LQ loop will not be created if Humana's proprietary codes do not have a HIPAA RARC associated to them. The LQ01 segment will contain the HE qualifier.

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Documentation to help you interpret your 835/Electronic Remittance Advice

Humana's Companion Guide to the HIPAA Implementation Guide for the 835 Health Care Claim Remittance/Advice
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Humana Remittance Advice Code Descriptions for claim adjudication
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