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 [email protected]
– 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.
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