Rite Aid 835 EDI – Payment Remittance Advice
Rite Aid 835 EDI is subjected to ‘Level 2’ or external testing as defined in the regulations on January 1, 2011 for the Health Insurance Portability and Accountability Act (HIPAA).
A very good way to examine the Rite Aid 835 EDI is to think of it as an explanation of benefits. What was paid and most importantly why. When a provider of service submits the claim (837) the responding 835 will detail the amount paid, how paid (EFT, ACH, Check). Included in the Rite Aid 835 EDI is the breakdown of the payment. It also details any changes in the details of what was billed. In some instances a provider of service may have billed for 3 services, yet the Rite Aid 835 EDI may have returned a different number of items. This is explained in the adjustment reason code that is returned. The discrepancy may be due to bundling, unbundling, or splitting of a claim. The key element is that the 835 will detail the information of what and why.
In many instances the claim is not paid for the amount billed. The Rite Aid 835 EDI describes, in great detail how the payment is broken down. In some cases the amount of payment is lower than the billed amount. This can be the result of bundling, line or claim splitting, coinsurance, deductable and in some instances the paid amount can potentially be higher than the billed amount.
In order to meet the needs of multiple Payers, Rite Aid established transaction specifications to accommodate the remittance type as defined in the October 2003 ASC X12 Standard referred to as Version 5, Release 1, Sub release 0 (005010) and the Errata versions.
As of January 2011 Rite Aid has been testing and implementing the base versions with external trading partners as well as the Errata Version. Our guidelines are in accordance to the unique Version/Release/Industry Identifier code for the Inbound 835 Health Care Claim Payment/Advice transaction set known as version 005010X221, 005010X221A1 and the National Council for Prescription Drug Programs (NCPDP).
Rite Aid Corporation is certified by the Data Interchanges Standards Association (DISA) to be in compliance with the Rite Aid 835 EDI Health Care Claim Payment/Advice Versions.