Remittance Advice 101. HPE Provider Relations/October 2016

Transcription

1 Remittance Advice 101 HPE Provider Relations/October 2016

2 Agenda General Information Search Payment History RA Summary Page Understanding the Remittance Advice Stale-Dated and Reissued Checks Helpful Tools Q&A 2

3 General Information

4 General Information One of the most significant tools an Indiana Health Coverage Programs (IHCP) provider has is the weekly Remittance Advice (RA) Lists all claims processed during the previous week s financial cycle Is available each Monday via Web interchange for 12 rolling weeks The Provider Healthcare Portal will house RAs indefinitely Each managed care entity (MCE) establishes and communicates its own financial processes 4

5 General Information The claim information is sorted according to claim type and status (paid, denied, in process) ZERO PAY REMITTANCE ADVICE download the PDF file and review it for: Paid claims Adjustments Accounts receivable information 5

6 Search Payment History

7 Accessing RAs on Web interchange Click here to download the RA EVERY week 7

8 RA PDF files are available for a rolling 12-week period Check # provides paid claim information 8

9 Search Payment History two options on the Portal 9

10 Search Payment History 10

11 Search Payment History 11

12 Provider Healthcare Portal Remittance Advice (RA) RA Sections Paid Claims Denied Claims Claims In Process Claim Void/Replacement Financial Transactions EOB/ARC Codes Summary 12

13 Web interchange Remittance Advice RA PDF files are available for a rolling 12-week period Provider information Member information RID ICN EOB codes 13

14 Provider Healthcare Portal Remittance Advice Header Provider information Internal Control Number Member name Member RID 14

15 Paid Claims - Crossover ** Medicare paid Medicaid allowed 94.24* Medicaid Medicaid due to provider.00 paid amount * The $45.52 co-insurance is a write-off for the provider it CANNOT be billed to the member Medicaid allowed amount 15

16 Paid Claims Third Party Liability (TPL) TPL Payment Medicaid Payment TPL Paid = Medicaid allowed = Medicaid Paid =.00 Medicaid allowed amount The remaining balance is a write-off for the provider it CANNOT be billed to the member Explanation of benefits (EOB) will read No payment made-tpl/spend-down is more than the Indiana Health Coverage Program allowed amount 16

17 Financial Transaction: Accounts Receivable (A/R) An A/R is money determined by the State or one of its contractors to be payable or owed to the IHCP. Usually, this is for voided/replaced claims, retro rates, or mass adjustments. 17

18 Financial Transaction - Accounts Receivable (A/R) Possible system-generated A/Rs can be identified on the Remittance Advice (RA) as A/Rs with internal control numbers (ICNs) that begin with the number 5: 50 Provider-Initiated Non-Check-Related Adjustments 51 Provider-Initiated Check-Related Adjustments 54 Void Transaction 55 Mass Adjustment Nursing Facility Retroactive Rate 56 Mass Adjustment See the Claims Submission and Processing Module Reference Materials 18

19 Financial Transaction Non-Claim-Specific Non-claim-specific financial transactions are transactions unrelated to a particular claim that affect a provider s payment Non-claim-specific refunds are refunds made by a provider to the IHCP that cannot be directly tied to a specific claim Non-claim-specific payouts are payments made to a provider that are not specific to a member or date of service 19

20 RA Summary Page

21 Summary Page 21

22 Stale-Dated and Reissued Checks

23 Stale-dated checks If a check is not presented for payment within 180 days after the date of issuance, the check is staledated and voided. When a check is stale-dated, all paid claims under that check will also be voided. Claims must be resubmitted for reimbursement. Reissue of checks In the event of a lost or missing check, providers can request a check to be reissued by calling HPE Customer Assistance at It is very important that pay to and electronic funds transfer (EFT) information is kept up-to-date checks are not forwarded via the postal service. 23

24 Helpful Tools

25 Helpful Tools IHCP website at indianamedicaid.com IHCP Provider Reference Modules Medical Policy Manual Customer Service Provider Relations Field Consultants Indianamedicaid.com>Provider Home page>contact Us Written Correspondence HPE Provider Written Correspondence PO Box 7263 Indianapolis, In

26 Q&A