What is a Remittance Advice?
A Remittance Advice (RA) is a notice of payments and adjustments sent to providers, billers, and suppliers. After a claim has been received and processed, your Medicare Contractor produces the RA, which may serve as a companion to a claim payment(s) or as an explanation when there is no payment. The RA explains the reimbursement decisions including the reasons for payments and adjustments of processed claims.
Providers use the RA to post payments and to review claim adjustments. The RA also contains detailed and specific claim decision information. An adjustment may be made for any number of reasons. These reasons are identified on the RA through standardized code sets which include Group Codes, Claim Adjustment Reason Codes, and RA Remark Codes.
Types of Remittance Advice
What are the different types of remittance advice?
A provider may receive an RA from Medicare transmitted in an electronic format, called the Electronic Remittance Advice (ERA), or in a paper format, called the Standard Paper Remittance Advice (SPR). Although the information featured on the ERA and SPR is similar, the two formats are arranged differently, and the ERA offers some data and administrative efficiencies not available in an SPR.
What are the benefits of receiving the Electronic Remittance Advice (ERA)?
The ERA offers many advantages such as:
- Data and data efficiencies not available in a paper remittance advice
- Faster communication and payment
- Faster account reconciliation via electronic posting
- Can be exchanged between partners with much greater ease than a paper remittance advice
- Providers information that is portable, reusable, retrievable and is easily stored
- Displays withholding/collection information on the Summary Page
If you are still receiving the paper remittance advice, sign up for electronic remittance advice! Software is available for providers to view and print Health Insurance Portability and Accountability Act-compliant ERAs from their own computer. If your current system does not have ERA capability, the PC Print software is available at no cost. This software is easy to use and will save you both time and money if you are currently receiving standard paper remittances (SPR).
To Begin Receiving Electronic Remittance Advice’s fill out and send us the: Submitter Action Request Form, and the Third Party Billing form: EDI Provider Authorization Form for Third-Party Billing.
Top Remittance Advice Frequently Asked Question’s
Top Ten Remittance Advice Questions
These are the ten most commonly asked questions about the Remittance Advice.
Remittance Advice Resources
“Understanding the Remittance Advice: A Guide for Medicare Providers, Physicians, Suppliers and Billers”
This guide, published by CMS, is a general summary of what you will see on an institutional or professional remittance advice. It also included general guidelines for balancing your remittances.
Part A Providers: Understanding the Remittance Advice PowerPoint
This PowerPoint will guide you through the difference fields and coding used on the remittance advice
Washington Publishing Company
This Web site contains lists of Group Codes, Claim Adjustment Reason Codes, and RA Remark Codes that are used on the remittance advice.
Section 935 Limitation on Recoupment
This PowerPoint will take you through the basic steps in the Limitation on Recoupment process including responding to demand letters and how file an appeal.
The two articles listed below will assist you with learning the basics of Limitation on Recoupment and how to interpret the remittance advice when you have adjustments subject to Section 935 Limitation on Recoupment
Section 935 Recoupment Basics
How to Interpret the Remittance Advice for Adjustments Subject to MMA Section 935 – RAC or Other Post-payment Review
Recovery Audit Contractor
This is a link to the provider portal for the Medicare Region A RAC : DCS Healthcare