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Electronic Remittance Advice

 

Medicare / Medicare HMO


To access the Remittance Advice click on Billing->Remittance Advice

 

Remittance Advice pull into AgencyCore for all agencies which are set up to bill electronically through Axxess. The Remittance Date parameter is set to a 60 day time frame prior to the current date.  The user may change the date range if desired.  Users who either choose not to electronically bill through Axxess or who are not yet linked may upload their Remittance Advice into Axxess. This is accomplished through the select Remittance file browse/upload option located in the upper middle portion of the page.  Once uploaded, the user will have the same functionality as remittances that come directly into Axxess.

 

*Note on uploaded Remittance Advice:  If wishing to post payments from the Remittance Advice three items must be fulfilled:

 

There are nine columns to the remittance file listings. First will be the Remittance Id. This is the Id associated the payment.  Next is the Remittance Date, followed by the Payor and then the date the agency can expect payment (Payment Date), the Last Posted Date, the payment amount (Provider Payment), the number of claims contained in the Remittance Advice (Claim Count), an Action Column and the Posted Status.

 

The Action column contains two actions: View Details and Delete.

 

The Delete action item will delete the remittance advice from the list.

 

Selecting View Details opens the Remittance Advice to allow the user to view the details and post payments to the patient's claim.

 

The Remittance Advice summary information pulls over to the remittance detail for quick review by the user.

 

Just below the summary information the user will find Payer (Intermediary) and Payee (Agency) information.

 

Located below the Payer and Payee information is the listing of the claims associated with the remittance advice.   In addition to the Patient Name and Medicare Number, each claim line item includes:

 

Patient Control Number: This field displays the Patient Control Number (PCN) that was submitted on the claim. The PCN is usually assigned by providers to each admission and provides an easy method for posting payments.

 

ICN Number is the internal control number.  It is a 14 digit unique number assigned to the claim at the time it is received by the Medicare Contractor (Intermediary). It is used to track and monitor the claim. The first six digits reflect when the claim was received. The first digit is a century code (“1” indicates 1900-1999 and “2” indicates 2000 and after). The second two digits indicate the last two digits of the year that the claim was received. The next three digits indicate the day of the year the claim was submitted, out of 365 days (366 in a leap year). The last eight digits are a unique set of numbers assigned by Medicare Contractors.

 

Start Date:  This field indicates the start date of services on the processed claim.

 

End Date: This field indicates the last date of services on the processed claim.

 

Type of Bill: is an identifier for the claim.  Examples of Types of Bills include 329 or 339: Final, 332: RAP, 328: reversal of previous payment (RAP) when Final billed,

 

Claim Status: identifies how the claim was processed.  This example shows a status of Processed as Primary (1). Other claim status examples include: Processed as Secondary, Processed as Tertiary, Reversal of Previous Payment and Denied.

 

Claim Number: is the number of the claim on the remittance advice.

 

Reported Charge: This field shows the dollar amount of charges submitted by the agency. This amount does not necessarily impact the provider's reimbursement amount.

 

Remittance: is the payment amount related to the reported charges.

 

Line Adjustment Amount: shows any amount adjusted on the claim.  A negative number is an addition to the payment and a positive number is a subtraction from the payment.  On final claims, the agency will see the RAP payment amount as a negative number.

 

And Paid Amount: is the total amount paid for the claim.

 

There are several ways to Post claim payments within AgencyCore.

 

An individual claim payment may be posted by using the Post button in the claim information.

 

To post several payments within a remittance advice the user would select the line item for each claim s/he wishes to post.

Once the claim line items are selected the user chooses Post Selected which is located at the top of the Remittance Detail.  The selected payments will then post to the claims.

 

The selection and Post button no longer appears once the payment has been posted for the claim.  Claim information and posting may be viewed through the Billing Claims History for the patient.

 

Hover over the Billing tab

 

Click on "Remittance Advice"

 

An EFT listing will appear; select "View Details" to open selected Remittance Advice.

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