What is an example of a remark code from an explanation of benefits document?

A remark code is a supplementary code that provides additional information about an adjustment made to a claim payment on an explanation of benefits (EOB) document. The code is used to communicate specific details regarding the claim processing and payment determinations.

The choice of contractual allowance pertains to the amount that an insurer and a provider have agreed upon and reflects any negotiated adjustments or agreements related to payment for specific services. This is often included on EOBs to inform the provider and the patient about the agreed-upon amounts versus what was billed. The remark code is designed to provide clarity on such adjustments and is essential for understanding the financial transactions involved.

In contrast, while deductible amount, patient responsibility, and special payment adjustment all relate to the claim and its payment, they do not specifically function as remark codes that clarify the reasoning behind the adjustments. Deductible amount refers to the portion of the expense the insured must pay before coverage takes effect, while patient responsibility indicates what the patient owes after insurance has processed the claim. Special payment adjustment often indicates non-standard payments but does not serve as a remark code in the same context as a contractual allowance.