Jurisdiction B DME MAC Supplier Manual Chapter 18: Supplier Remittance Notice [MARCH 2011] 18 Supplier Remittance Notice GENERAL INFORMATION Once a claim has completed processing through the Medicare system, a supplier remittance notice is generated for all suppliers for all claims, whether they file paper or electronic claims. For those suppliers that file nonassigned claims, a supplier remittance notice will be sent and the beneficiary will receive notice of adjudication on nonassigned claims in the form of the Medicare Summary Notice (MSN). The supplier remittance notice includes a list of all claims paid or denied during a particular payment period. Included with the supplier remittance notice is the Medicare check for those claims that are approved for payment. The standard paper remittance (SPR) notice is the product of the Centers for Medicare & Medicaid Services (CMS) standardization of provider/supplier payment notification. This remittance form was created to:   provide a new remittance notice that is uniform in both content and format; and ease the transition to the electronic remittance notice media. As part of the effort to eliminate any variations in the administration of Medicare across the country, and to furnish a uniform level of information to all providers of health care about the decisions made on their claims, a standardized set of codes have been created to explain how a claim has been processed. Under the standard format, only codes approved by the American National Standards Institute (ANSI) insurance subcommittee, and Medicare-specific supplemental messages approved by CMS, may be used. ANSI is a nongovernmental association of which CMS is a member. TIPS FOR READING THE REMITTANCE NOTICE      One claim is listed in each block of the remittance, and is separated from other claims with a line. Claims are listed in alphabetical order by patient’s last name. The columnar dollar amount fields for each line of the claim are totaled down and are displayed in the CLAIM TOTALS fields; these lines cannot be totaled across. ANSI Group, Reason, Remark and Medicare Outpatient Adjudication (MOA) codes are listed in the key at the end of the remittance notice. A TOTALS line that includes all claims on the remittance notice, as well as offsets and other adjustments, is located at the end of the suppler remittance notice. The net pay field on this line equals the amount of the check. Claim Control Numbers When claims are entered into the Medicare system, they are issued a tracking number known as a claim control number (CCN) (also referred to as the internal control number [ICN]). 132_0311 1 Jurisdiction B DME MAC Supplier Manual Chapter 18: Supplier Remittance Notice [MARCH 2011] The first five digits of the 14-digit ICN/CCN indicate the date (in Julian date format) when Medicare received the claim. The Julian date is expressed by the first two digits being the year and the next three digits are the sequential numbering of the days of the year. The CCN/ICN also indicates whether the claim was submitted on paper or electronically or if it was electronically transferred from another durable medical equipment Medicare administrative contractor (DME MAC) jurisdiction (6th digit). Finally, the last digit of the CCN indicates if the claim is an initial claim or an adjusted claim. If the last digit is 1 or higher, the claim has been adjusted. ANSI and MOA Codes Medicare uses codes to explain the determination of a claim. All Medicare contractors are required to use ANSI codes. The DME MACs also use some Medicare specific codes called MOA codes. Each twodigit ANSI Reason code is preceded by one of the following two-letter ANSI group codes:    PR = Patient responsibility; it indicates that the patient is financially responsible for the claim or claim line CO = Contractual obligation; it means that the supplier is financially responsible for the claim or claim line OA = Other adjustment The narrative description of each Remark code is given in the Glossary at the end of the supplier remittance notice. Note: Suppliers receiving the ERA must rely solely on downloading the ERA files. This is true whether the ERA is received directly or through a billing agent, clearinghouse or other entity representing the supplier’s company. For information on the suppression of SPRs, refer to CMS Medicare Learning Network Matters article MM4376 at www.cms.gov/MLNMattersArticles/downloads/MM4376.pdf. 132_0311 2 Jurisdiction B DME MAC Supplier Manual Chapter 18: Supplier Remittance Notice [MARCH 2011] SAMPLE REMITTANCE NOTICE 132_0311 3 Jurisdiction B DME MAC Supplier Manual Chapter 18: Supplier Remittance Notice [MARCH 2011] REMITTANCE NOTICE KEY Field Remittance Notice Header: PROVIDER NAME AND ADDRESS Description The name and address of the billing supplier. PROVIDER NUMBER The National Provider Identifier (NPI) of the billing supplier and the number used to process the claims listed. PAGE NUMBER This field lists the current page number and the total number of pages of the remittance notice. DATE The date the remittance notice was generated. This date is the same as the date on the check. CHECK/EFT # The number in this field corresponds to the number on the check (if issued). The EFT # is the bank tracer number. STATEMENT # System generated number for tracking. PROVIDER BULLETIN This field is reserved for a general notice that is published to all suppliers on each remittance notice. Individual Claim Summary: PERF PROV The NPI of the performing supplier. SERV DATE Service date as submitted on the claim. The lines within each claim are in descending order by the service date. POS Place of Service as billed on the claim. NOS Number (or units) of services as billed on the claim. PROC The HCPCS procedure code as submitted on the claim. If we change the code during processing, the billed code is listed below the approved code. MODS HCPCS modifiers which were submitted on the claim. BILLED The supplier’s submitted charge. ALLOWED The Medicare allowed amount prior to any deductions or offsets. DEDUCT The portion of the Medicare allowed amount that was applied to the patient's deductible. COINS The 20 percent coinsurance (based off the allowed amount after deductible) which is due by the patient. PROV PD The amount Medicare is paying to the supplier. RC-AMT The Adjustment Reason Code amount. These amounts are deducted from claim payment and do not include the deductible and coinsurance due by the patient. If there is more than one code, additional adjustment codes and remarks appear on the next line. NAME The patient’s name on the claim. HIC The patient’s Medicare number. AC The patient’s account number that has been assigned by the supplier. This number is 132_0311 4 Jurisdiction B DME MAC Supplier Manual Chapter 18: Supplier Remittance Notice [MARCH 2011] Field Description listed when submitted on an electronic claim. ICN Internal Control Number. The CCN assigned to the claim in Julian date form. ASG The assignment value of the claim. “Y” indicates the claim is assigned, “N” means the claim is nonassigned. MOA Medicare Outpatient Adjudication Remark code. Up to five codes per line item may appear. These codes define the processing action taken on the line item of the claim. REM Remark Codes. Additional information regarding the claim. PT RESP Patient responsibility. This column will include amounts for noncovered services, deductible and coinsurance. CLAIM TOTALS This is the claim total line for each column. ADJUSTMENTS Adjustments that are made to the allowed amount for each individual claim and affect the total net. NET Net amount paid for individual claim. Total Remittance Summary: REMITTANCE TOTALS The net amount of the supplier’s check. The net amount is determined by:        ADJS PREV PD Claim Total Allowed Amount Deductible Coinsurance Reason Code Amounts Previous Paid Interest Other dollar amounts Adjustments which are made to the allowed amount and affect the total net. These include the fields below. On adjusted claims, this is the amount previously paid on the original claim. PD TO PATIENT Paid to patient. When the patient has paid the supplier more than the applicable coinsurance and deductible, that overpayment is refunded to the patient from the supplier’s payment. INT Interest that has accrued because a clean claim did not complete processing within 30 days. MSP The amount paid by the primary insurer for Medicare Secondary Payer (MSP) claims. OTHER Other adjustments to the supplier’s payment. These could include a reduction due to overpayment recovery offset, a waiver offset, or IRS withholdings. OFFSET The Financial Control Number (FCN), Health Insurance Claim Number (HICN) and dollar amount regarding offset. Glossary: CODES 132_0311 Detailed information defining the codes. 5 Jurisdiction B DME MAC Supplier Manual Chapter 18: Supplier Remittance Notice [MARCH 2011] RESOURCES  CMS Web-based Training: Understanding the Remittance Advice for Professional Providers; http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=1 132_0311 6