The RA may include the following information:

• Patient name
• Patient Health Insurance Claim (HIC) number
• Rendering Provider’s Name
• Dates of service
• Type of service (TOS), Procedure Codes and Modifiers
• Charges (submitted, allowed)
• Payment, including any deductions (and copayments)
• Reason and/or remark codes
• Indication your claim has been forwarded to the supplemental carrier for processing

For additional information on the standard paper remittance, click here: Standard Paper Remittance

The standard paper remittance is limited to claim-level information. For more detailed adjudicated claim information, the electronic remittance advice is available.

Electronic Remittance Advice (ERA)

It is to the provider’s advantage to opt for the electronic remittance advice for the following reasons:

• Eliminates mail time
• Same information as the paper remittance plus line-level detail as well as noncovered detail
• Includes all reason and remark codes applicable to the claim
• Allows for creation of ad hoc reports (if supported by your software application)
• Allows for automated posting (if supported by your software application)

Reason and Remark Codes

As mentioned above, the RA may include reason and remark codes. Reason codes explain the basic reason for a denial or reduction of a claim for service. Remark codes, on the other hand, are used to clarify a reason code. A remark code may express a policy or coverage rule for a plan that underlies the decision expressed in the reason code, express appeal rights that accompany the decision expressed in a reason code, or something similar. Reason codes are usually generic for use by any health payer, but remark codes can be more specific to the policy of a particular payer. Remark codes cannot be used by themselves to deny or reduce payment on a claim or service. They can, however, be used for informational purposes.

For a complete listing of reason and remark codes, go to: www.wpc-edi.com/codes.