provider web portal quick guide – reading your remittance ......feb 13, 2018 · the downloadable...

UPDATED 02/13/18

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Provider Web Portal Quick Guide – Reading Your Remittance Advice (RA) RA Sections and Page Numbering The downloadable RA file (PDF) will not include every page included in the printable RA. Downloadable PDF versions of the RA may appear to be missing pages, due to the page numbers on the RA, but this is not the case. To better understand which pages will appear in your downloaded version of the RA, please see descriptions below. Address Cover Page: Page 1 will never appear in the downloadable PDF file, as it is the address cover page used when mailing an RA. Banner Message Section: If applicable, the Banner Message section appears starting on page 2. This section may take up multiple pages in order to display all configured messages. Payment Notice Section: Like the address cover page, the Payment Notice section will never appear in the PDF file, as it is used for printing a physical check or EFT notice when mailing an RA. The Payment Notice section appears only on the printed version of the RA, and only if the payee has a non-zero payment due. This can be identified by the “Check/EFT Number” displayed on the section headers of the RA. If the number is all zeros, then there is no payment due and this section will not exist (there are no pages to be omitted). If it is a non-zero number, then a payment was produced, and this section was included in the printed version of the RA. The Payment Notice section follows the last page of the previous section, but will appear as omitted pages. Example 1: If the Banner Message section requires two pages (pages 2 and 3), the Payment Notice section would be numbered as Page 4. Page 4 would be omitted from the PDF file. The next page of the PDF file would begin on page 5. Example 2: If the Banner Message section is not present, the Payment Notice section would be numbered as Page 2. Page 2 would be omitted from the PDF file. The first page of the PDF file would begin on page 3. Example 3: If none of these sections are present, the first page of the PDF file would begin on page 2. The remaining pages of the RA begin with the next page number available, after the last page of the previous section.

http://colorado.gov/hcpf

READ YOUR REMITTANCE ADVICE (RA) PROVIDER WEB PORTAL QUICK GUIDE

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Interpreting Claim Numbers Each claim and adjustment received by Health First Colorado (Colorado’s Medicaid Program) is assigned a unique claim number, known as the internal control number (ICN). This number identifies valuable information about the claim and adjustment request. The following diagram and table provide detailed information about interpreting the claim number.

Type of Number and Description

Applicable Number and Description

Region – Two digits indicate the region. The region indicates how Health First Colorado received the claim or adjustment request.

10 – Paper Claims with No Attachments 11 – Paper Claim with Attachments 20, 21 – Batch Claim 22 – Web Portal Claim with No Attachments 23 – Web Portal Claim with Attachments 25 – PBM Pharmacy Claims 30, 31, 40 – Claims Converted from Old MMIS 50 – Provider Initiated Adjustment (via paper) 51, 52, 53, 55, 57, 58 – System Initiated Adjustments 54 – Mass Void 56 – Mass Void Request or Single Claim Void 59 – Provider Initiated Electronic Adjustment 80 – Claim Resubmission by DXC Systems Engineer 92 – Batch Reconsideration Claims with Attachments 93 – Provider Initiated Batch Reconsideration Adjustment with Attachments 94 – Web Portal Reconsideration Claims with Attachments (Note: If OZ is used for attachment, this region code will be automatically assigned. An OZ attachment is only required for Reconsideration claims) 95 – Provider Initiated Web Portal Reconsideration Adjustment with Attachments

Year – Two digits indicate the year Health First Colorado received the claim or adjustment request.

For example, the year 2017 would appear as 17.

Julian Date – Three digits indicate the day of the year, by Julian date, that Health First Colorado received the claim or adjustment request.

For example, February 3 would appear as 034.


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Type of Number and Description

Applicable Number and Description

Batch Range – Three digits indicate the batch range assigned to the claim.

The batch range is used internally by Health First Colorado.

Sequence Number – Three digits indicate the sequence number assigned within the batch range.

The sequence number is used internally by Health First Colorado.


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Adjustments and Recoupments Providers will see a Claim Adjustments section in the Remittance Advice (RA) if any of their claims were adjusted during the current financial cycle.

• Adjustments can only be done on claims in a Paid status. • Adjustments can be provider initiated. • Adjustments can be system generated. • Recoupments are generally done on the same RA as the adjusted claim.

o Exception: Provider does not have enough paid claims to satisfy the recoupments. If the recoupment amount exceeds the paid claim amount, the recoupment will continue to the next weeks’ RA until the total amount is recouped. See Scenario 2, Figures 4-8, for more information.

• Claim information will appear in the adjustment section for each claim type. • Additional payment or overpayment to be withheld will be listed for each adjustment.

See the Claim Adjustment section in the figure below for Scenario 1.

Figure 1. RA Claim Adjustment - Additional Payment


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Financial Transaction Page The Financial Transactions page details the provider's weekly financial activity. Financial transactions reported on the RA include payouts, refunds, accounts receivable and payments for claims. Under the Accounts Receivable section (bottom half of Figure 2), the following information is provided:

• A/R Number • Setup Date • Original Amount • Recoupment Amount to Date • Balance • Reason Code • Adjustment ICN • Previous ICN • Amount Recouped in Current Cycle

See the Financial Transaction page in the figure below for Scenario 1.

Figure 2. RA Financial Transactions - Initial AR Setup


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See the Summary page in the figure below for Scenario 1.

Figure 3. RA Summary 2


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See a full set of RAs for Scenario 2 in the figures below.

Figure 4. RA Claim Adjustment – Overpayment to be Withheld


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Figure 5. RA Financial Transaction – Initial AR Setup

Figure 6. RA Financial Transaction – First AR Withholdings


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Figure 7. RA Financial Transaction – Final AR Withholdings


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Figure 8. RA Summary


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Recognizing Co-payments Co-pay represents the amount of member responsibility on a claim detail that is to be collected by the provider at the time the service is rendered. Co-pay is used interchangeably with coinsurance.

Co-pay appears on the RA as “COPAY AMT CO-INS CB” for the following RA types: • Dental Claim Adjustments • Dental Claims Paid • Professional Service Claim Adjustments • Professional Service Claims Paid

Co-pay appears on the RA as “COPAY AMT” for the following RA types: • Remittance Advice - Outpatient Claim Adjustments • Remittance Advice - Outpatient Claims Paid

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Co-pay appears on the RA as “COPAY AMT SPENDOWN” for the following RA types:

• Remittance Advice - Medicare Crossover Institutional Claim Adjustments • Remittance Advice - Medicare Crossover Institutional Claims Paid • Remittance Advice - Medicare Crossover Professional Service Claim Adjustments • Remittance Advice - Medicare Crossover Professional Service Claims Paid • Remittance Advice - Medicare Crossover Institutional Claims Denied

Co-pay appears on the RA as “BILLED COPAY” for the following RA types: • Remittance Advice - Medicare Crossover Professional Service Claims Denied • Remittance Advice - Medicare Crossover Professional Service Claims In Process


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Co-pay appears on the RA as “CO-INS” for the following RA types: • Remittance Advice - Medicare Crossover Institutional Claims In Process

Co-pay appears on the RA as “COPAY AMOUNT” for the following RA types: • Remittance Advice - Outpatient Claims Denied

Using a Comma-Separated Values (CSV) File A CSV file is a file format accepted by a wide range of computer software programs. Downloadable CSV-formatted RAs allow users the benefits of building a customized RA specific to their use and saving the file to their computer. The CSV file on a provider's Web Portal appears as linear text separated by commas until it is downloaded into a compatible software program. Once downloaded, the file may be saved to a user's computer and the data manipulated, as desired. To access the CSV file, providers should select the “Search Payment History” option from the left side of the provider’s Web Portal home page. From the Search Payment History page providers can search for a given payment. The RA CSV file is listed for each payment returned


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in the search. The provider can click on the icon under the RA Copy (Delimited) column to download the CSV file. Formats include:

• Microsoft Office Excel • Microsoft Office Access • OpenOffice 2.2.1 — free software program available

Free spreadsheet applications can be found at:

• Google Docs • ZDNet • Other software applications may be available


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Need More Help?

Please visit the Quick Guides and Webinars web page to find all the Provider Web Portal Quick Guides:

Aid Code and Benefit Plan Acronyms Updating your EFT/ERA Information Are You Billing from the Correct Account?

Validating a Trading Partner ID (TPID)

Copy, Adjust, or Void a Claim Verifying Member Eligibility • Managed Care Assignments • Primary Care Provider • Medicare Coverage • Member Co-Pay Amounts

Delegates Delegate Access Definitions Entering Third Party Liability Provider Maintenance Pulling your 835 - Linking to your own TPID

Viewing Prior Authorizations in the Portal

Pulling your Remittance Advice (RA) Web Portal Registration Reading your Remittance Advice (RA)

• Internal Control Number (ICN) Information Sheet

• Region Code Information Sheet

Provider Web Portal – Frequently Asked Questions (FAQs) Please visit the Provider FAQ Central web page and look under the Billing and Web Portal headings to see Provider Web Portal FAQs.

Provider Web Portal – Recorded Webinars Click the links below to access the recorded webinars:

Session #1 Access the new Portal, Portal Registration, Log in, My Profile, Manage Accounts (including delegates)

Session #2 Provider Maintenance (including updates and affiliations), EFT/ERA Enrollment, Disenroll

Session #3 Member Information and Eligibility Verification

Session #4 Remittance Advice (RA), Search Payment History, Search for Accounts Receivable Records, Make a Payment

Session #5 Notify Me, Alerts, Secure Correspondence

Session #6 Files Exchange, Resources

Session #7 Search & Submit CMS 1500, UB-04, Emergency Dental Claims, Prior Authorizations (Nursing Facility PETI PARs only)

Bridge Bridge training for Community Centered Boards (CCBs) only

https://www.colorado.gov/pacific/hcpf/interchange-resources

https://www.colorado.gov/pacific/hcpf/faq-central#interChangeResources

https://attendee.gotowebinar.com/register/7848999374715155457








provider web portal quick guide – reading your remittance ......feb 13, 2018 · the downloadable...

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