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CMS Manual System
CMS Manual System Department of Health & Human Services (DHHS) Pub. 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 470 Date: FEBRUARY 4, 2005 CHANGE REQUEST 3685 SUBJECT: Standardization of Fiscal Intermediary Use of Group and Claim Adjustment Reason Codes and Calculation and Balancing of TS2 and TS3 Segment Data Elements I. SUMMARY OF CHANGES: This contains requirements for standardized reporting of group and claim adjustment reason code pairs, and calculation and balancing of TS 3 and TS2 segment data elements reported in Fiscal Intermediary remittance advice and coordination of benefit transactions.
advice that a beneficiary is liable unless an Advance Beneficiary Notice (ABN) or other notice of non-coverage has been delivered to the beneficiary that properly advises the beneficiary of the reason(s) Medicare will not pay for the item and/or service. See Pub 100-04/30 for more information on these protections.
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