Indiana Health Coverage Programs

DXC Technology

Fee-for-Service –

Understanding Your

Remittance Advice

Annual Provider Seminar ‒ October 2018

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Agenda• Remittance Advice overview

• Remittance Advice sample pages

• Remittance Advices on the Provider Healthcare Portal

• Helpful tools

• Questions

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Remittance Advice overview

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Remittance Advice overview

• Financial cycle each Friday after COB– Payments equal paid claims less outstanding ARs (accounts receivable) and non-claim-

specific transactions.

• Checks dated each Wednesday– Electronic funds transfer (EFT) deposited each Wednesday

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Remittance Advice overview

• RA available via the Provider

Healthcare Portal Monday morning

• Access Provider Healthcare Portal

weekly to download and save RAs

• Prior RAs available back to February

21, 2017

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Remittance Advice overview

• Provides information on paid, denied, adjusted, or suspended claims

• Reports claim activity for each week

• Contains information about other financial transactions

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Remittance Advice overview

• Information subtotaled for each section

• Includes financial summary page

• Information is standardized for all claim types

• Refer to the Financial Transactions and

Remittance Advice provider reference module

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Requesting paper Remittance Advices

• Request RAs from Written Correspondence Unit:– Through Provider Healthcare Portal’s “Secure Correspondence”

– Email request to inxixwrittencorr@dxc.com

– Mail request on provider letterhead

– Mail request on IHCP Written Inquiry form

– Mail requests to:

DXC Written Correspondence

P.O. Box 7263

Indianapolis, IN 46207-7263

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Electronic Remittance Advices

• 835 Health Care Claim Payment/Advice

• Requires trading partner agreement

• Enroll for 835 on the Provider Healthcare Portal– My Home > Provider Maintenance > ERA Changes

• 835 Implementation Guide available from Washington

Publishing Company ‒ wpc-edi.com

• At indianamedicaid.com– IHCP 835 Companion Guide

– Electronic Data Interchange provider reference module

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• Claims Paid

• Claims Denied

• Claims in Process

• Claims Adjustments

• Payment Holds

• Financial Transactions

• Refunds

• Financial Summary

• Descriptions:– EOB codes

– ARC codes

– REMARK codes

– Service codes

Remittance Advice ‒ sections

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Remittance Advice sample pages

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Remittance Advice ‒ paid claim

ICN PATIENT NUMBER MRN SERVICE DATES SERVICE DATES BILLED AMT OTH INS AMT COPAY AMT PAID AMT

FROM TO ALLOWED AMT SPENDOWN AMT CO-INS CB OUTPAT DED

MEMBER NAME XXXXXX MEMBER NO XXXXXX

XXXXXX XXXXXX XXX 053118 053118 61.00 0.00 0.00 15.46

15.46 0.00 0.00 0.00

SERVICE DATES SERVICE DATES ALLOW UNITS REN PROV XXXX PA # XXX

PROC CD MODIFIERS FROM TO COPAY AMT BILLED AMT ALLOWED AMT PAID AMT

90853 AJ 053118 053118 1.00

0.00 61.00 15.46 15.46

EOBS 001 9806 9920

ARCS 001 45

BILLED AMOUNT - SUM OF ARCS = PAID AMOUNT

61.00 45.54 15.46

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Remittance Advice ‒ adjusted claim

Adjusted claim

New claim

ICN #

ICN #

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Remittance Advice ‒ non-claim-

specific transactions

Financial transactions not related to a specific claim

Financial transactions

not related to a

specific claim

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Remittance Advice ‒ accounts

receivable

• Accounts receivables are set

up when claims are adjusted.

• Adjusted ICN, new ICN, and

AR numbers are displayed.

• ARs may be recouped in

current cycle or future cycles.

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Remittance Advice ‒ financial

summary

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EOB codes

• EOB codes describe reasons why claims were adjusted, suspended,

denied, or did not pay in full

• EOB codes are IHCP-specific:– Cannot be written to the 835 electronic transaction

– Only national standard ARC and REMARK codes are included in

835 electronic transaction

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IHCP EOB codes

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ARC (Adjustment Reason Codes)

• Alphanumeric codes from national code set used with the 835

Implementation Guide

• Explain adjustments from billed amount to paid amount

• Reported at claim level (header) and service line level (detail)

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ARC codes

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REMARK codes

• Similar to ARC codes

• Post only when additional information needed to explain why claim denies

or does not pay in full

• Specific ARC and REMARK codes are related:– ARC 16 – Claim/service lacks information or has submission/billing errors

– REMARK M47 – Missing/incomplete/invalid payer claim control number

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REMARK codes

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Service codes

• HCPCS/CPT procedure codes contained in the Remittance Advice are

listed:

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Using the Search tool

Right-click > FIND > OPEN FULL READER SEARCH to search by key word: “Total”

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Remittance Advices on the

IHCP Provider Healthcare Portal

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Search Payment History

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Searching for Remittance Advices

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Reminder

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Claim filing limit

The IHCP will mandate a 180-day filing limit for fee-for-service (FFS) claims,

effective January 1, 2019. Refer to BT201829, published on June 19, 2018,

for additional details.

• The 180-day filing limit will be effective based on date of service:– Any services rendered on or after January 1, 2019, will be subject to the 180-day filing

limit.

– Dates of service before January 1, 2019, will be subject to the 365-day filing limit.

Watch for additional communications!

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Helpful tools

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Helpful tools

Provider Relations

Consultants

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Helpful tools

IHCP website at indianamedicaid.com:

• IHCP Provider Reference Modules

• Medical Policy Manual

• Contact Us – Provider Relations Field Consultants

Customer Assistance available:

• Monday – Friday, 8 a.m. – 6 p.m. Eastern Time

• 1-800-457-4584

Secure Correspondence:

• Via the Provider Healthcare Portal

• Written Correspondence:DXC Technology Provider Written Correspondence

P.O. Box 7263

Indianapolis, In 46207-7263

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QuestionsFollowing this session, please review your schedule for the next session

you are registered to attend.