How to Read the Remittance Advice

• Sample RAs and descriptions
• Additional RA pages
• Explanation of Benefit (EOB) codes
• Current system RA information

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Sample RAs and descriptions (PDF files)

• CMS 1500 
• Leveraged Claims: payable - not paid; payments due - detail
• Medicare B Crossover Claims 
• Institutional (UB-04): Medicare A Crossover; Hospital Outpatient; Hospital Inpatient; Home Health 
• Dental 
• Drug; Compound Drug 

Additional RA pages (PDF files)

The following pages are common to all outgoing RAs:

• Banner Page - This page is a cover page to all outgoing RAs with space for a messages from DHS (limit 4000 characters).
• Explanation of Benefit (EOB) descriptions - This page is an ending to all outgoing RAs that contains the descriptions for all EOBs listed on the RA.
• Financial Transactions Summary - This page describes non-claim financial activity such as accounts receivable or accounts payable information.
• RA Summary - This page provides a summary of all activity reported on the RA, including claim activity.

The following pages are included if applicable:

• Third-Party Liability (TPL) information - This page provides information on how third-party resources affected the processing of the claims reported on the RA.
• Garnishment Detail - This page provides information about any payments made to garnishments or lien-holders. 

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Explanation of Benefit (EOB) codes

The new EOB codes you see on the RA are based on the HIPAA Claims Adjustment Reason Codes available on the Washington Publishing Web site. Your RA will list the specific EOB descriptions for all EOBs listed on your RA.

Current system RA information

This slideshow (PDF or Powerpoint) tells you how to read the current system RA and what to do when you receive an RA for underpaid, overpaid or denied claims.

Providers will receive their last RA (PDF) in the current MMIS the week of December 1. The following text explains the fields shown in the current RA.

1. Your provider name and provider number.
2. The date the RA was printed. It will be the same date on your check. Refer to this number if inquiring about an RA.
3. The unique number DMAP assigns to each RA; however, when inquiring about the RA, refer to the date of the RA (see #2) rather than this number.
4. The sequential page number for this RA.
5. The clients’ names in alphabetical order.
6. The clients’ recipient ID numbers.
7. This is the unique number assigned by DMAP to each claim during processing. Reference this number when completing the adjustment form.
8. If a patient account number was listed on the claim form, it will be printed in this space.
9. The date of service listed on the claim form. The type of service and procedure code listed on the claim form.
10. The type of service and procedure code listed on the claim form.
11. The number of services billed for this procedure code on the claim form.
12. The amount billed for this service on the claim form.
13. The amount paid by another source, such as, patient liability, private insurance, or Medicare.
14. The amount paid by DMAP.
15. These numbers correspond to the written messages in the lower portion of the RA.
16. Subtotals from the billed amounts, third party liability (TPL) credits applied, and DMAP payment amounts on this RA.
17. This section contains payment information in two columns: "Current" (payments this RA) and "Year to Date" (all payments this calendar year).
18. Claims Message Codes, also called Explanation of Benefits (EOB): Computer messages that indicate how the claim was processed, if more information is needed to process the claim, or if payment was denied.

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