Gateway 835 Companion Documents

Effective December 08, 2003, providers may begin receiving electronic claims remittance advice (ERA). Gateway Health Plan^® will use WebMD to transfer the 835 Version 4010A Healthcare Claim Remittance Advice to claim submitters.

These Companion Documents provide information about the 835 Claim Remittance Advice Transaction that is specific to Gateway Health Plan^® and Gateway Health Plan^® trading partners. Companion Documents are intended to supplement the HIPAA Implementation Guides. Rules for format, content, and field values can be found in the Implementation Guides available on the Washington Publishing Company’s website.

Due to the evolving nature of HIPAA regulations, these documents are subject to change. Substantial effort has been taken to minimize conflicts or errors. Please contact Gateway HIPPA Contact with your HIPAA 835 Companion Documents questions.

Claim Adjustment Codes

There is a distinct data variation between the current Gateway HeGateway Health Plan Claims Remittance Advice and the 835 Transaction. The difference occurs in the code sets that tell claim submitters the results of each claim’s adjudication. Few Gateway Health Plan^® and HIPAA Adjustment Reason Codes have solid, unambiguous matches at the same level of detail. A crosswalk has been created in attempt to ease the code set transition.