CHAPTER 3: READING AN INSTITUTIONAL REMITTANCE ADVICE (RA) RECEIVED FROM FISCAL
4.2 READING A PROFESSIONAL ELECTRONIC REMITTANCE ADVICE (ERA)
4.2.6 Generating Special Reports Using the MREP Software
In addition to the tabbed view that gives providers multiple ways in which to view remittance
information, the MREP software provides several automated special reports. The Entire Remittance Report is discussed in Section 4.2.4. Additional special reports include:
The Denied Service Lines Report The Adjusted Service Lines Report The Deductible Service Lines Report
Figure 4-10. The Denied Service Lines Report
CARRIER -This field displays the name of the Medicare Carrier that processed the claim(s) and produced the 835.
PAYEE # -This field indicates the Medicare Provider Number of the provider receiving the 835. The Medicare Provider Number is the number assigned to the provider for billing and identification purposes.
NOTE: The National Provider Identifier (NPI) will eventually replace the Medicare Provider Number. For more information, visit
www.cms.hhs.gov/NationalProvIdentStand/ on the CMS website.
PAYEE NAME -This field displays the name of the provider that submitted the claims addressed in this 835.
CHK DATE -This field displays the date on which payment was issued for the claims processed in this 835.
CHK/EFT # -This field indicates the check or EFT transaction number through which payment was issued. If a paper check is issued, this field contains the check number. The RA number is inserted if no payment is issued.
SEQ # -This field indicates the sequence number assigned by the MREP software and is not a field from the 835.
PROVIDER # -This field indicates the Medicare Provider Number of the provider receiving the 835. The Medicare Provider Number is the number assigned to the provider for billing and identification purposes. This is identical to the PAYEE # field listed above.
NOTE: The National Provider Identifier (NPI) will eventually replace the Medicare Provider Number. For more information, visit
www.cms.hhs.gov/NationalProvIdentStand/ on the CMS website.
ACNT # / NAME -This field displays the account number (any internal number assigned to the individual electronic claim by the provider; a zero appears if no internal number is submitted with the claim) and the last name and first name of the beneficiary for whom the claim was processed.
ICN/HICN -This field contains the Internal Control Number (ICN) and the Health Insurance Claim Number (HICN). The ICN is a unique 13-digit number assigned to the claim at the time it is received by the Carrier. It is used to track and monitor the claim. The HICN is the number of the beneficiary for whom the claim was processed.
LN # -This field indicates which service line within a particular claim is being referenced on this report.
SERVICE DATE(S) - This field displays the date(s) of service.
PROC/MOD -This field indicates the Healthcare Common Procedure Coding System (HCPCS) procedure code and all modifiers billed with the specified procedure. Information on HCPCS codes (including a list of Level II HCPCS codes) may be found at www.cms.hhs.gov/
DEDUCT -This field displays the amount of any deductible applied to the service line. If an amount is displayed in this field, this is the amount that the beneficiary (or other insurer, if applicable) is responsible for paying the provider.
For 2006, there is a yearly deductible of $124.00 for professional services. Some
supplemental insurance plans may cover the deductible amount.
NOTE: Deductible amounts are subject to change annually.
COINS -This field displays the coinsurance amount. If an amount is displayed in this field, this is the amount that the beneficiary (or other insurer, if applicable) is responsible for paying the provider.
For Part B coinsurance, the beneficiary is responsible for 20% of the allowed charges. Some beneficiaries have insurance that pays this 20%. The coinsurance for most outpatient mental health care is 50%.
NOTE: Coinsurance amounts are subject to change annually.
PD TO PROV - This field contains the total amount that the provider was paid for the service.
REASON CODE -This field contains any Group Codes and Claim Adjustment Reason Codes (CARCs) associated with this service line. There are four possible Group Codes for Medicare. See Table 2-3 in Chapter 2 of this Guide for a list of Group Codes.
REMARK CODES -This field indicates any Remittance Advice Remark Codes (RARCs) associated with the claim.
CARCs and RARCs are listed along with their definitions in the glossary section of the SPR. A complete listing of CARCs and RARCs can be found at www.wpc-edi.com/codes on the web.
4.2.6.2 The Adjusted Service Lines Report
The Adjusted Service Lines report shows claims that have a status of 22 (reversal of previous
payment). This report does not show the adjustment claim that reflects the corrected dollar amounts, but shows only the negative amount that the reversed claim provides to negate the original claim.
Figure 4-11. The Adjusted Service Lines Report
For definitions of the fields that appear on the Adjusted Service Lines report, see Section 4.2.6.1, The Denied Service Lines report. All field definitions apply to all types of reports.
4.2.6.3 The Deductible Service Lines Report
The Deductible Service Lines report lists all service lines that have a deductible amount. This report allows providers to view quickly those claims for which beneficiaries (or other insurer, if applicable) must pay some portion of the deductible.
Figure 4-12. The Deductible Service Lines Report
For definitions of the fields that appear on the Deductible Service Lines report, see Section 4.2.6.1, The Denied Service Lines report. All field definitions apply to all types of reports.