How to Read Your PDF RA

Revised: 08-11-2014

MHCP divides the remittance advice to health care providers into two parts: claims data (RA01) and supplemental data (RA02). Refer also to Remittance Advice (RA) Guide Chart DHS-7400 (PDF).

Claims Data

Claims appear in the following order of claim status on the MHCP PDF RA. If a claim category was not adjudicated in the last payment cycle, it will not appear on the RA for that payment cycle.

  • • Reversals
  • Claims that have been completely reversed
  • Replacement claim take-backs (repayments appear under Paid Primary)
  • • Paid Primary
  • • Claims that MHCP paid as the primary (only) payer claims
  • • Replacement claim repayments (take-backs appear under Reversals)
  • Paid Secondary are claims MHCP paid after coordination of benefits (COB), with one other payer (Medicare or other health coverage - OHC)
  • Paid Tertiary are claims MHCP paid after COB, with two or more other payers (Medicare, OHC)
  • Denied are claims MHCP denied
  • MHCP sorts the claims within each claim status section in alpha order by the recipient’s last name. Providers may request one of the following other sort options:

  • • PMI number
  • • Provider’s own reference or patient account number
  • • Payer Claim Control Number (PCN)
  • Supplemental Data

    Supplemental data is a separate document that consists of a list of any suspended claims and a Financial Summary Information page. Supplemental data is not a HIPAA-compliant transaction, cannot be sent with HIPAA compliant information and is not included with the X12 835 RA transactions.

    Reconciling Charges

    MHCP uses HIPAA-compliant adjustment codes available through the WPC Web site (Claim Status, Claim Status Category, Adjustment Group Reason and Remarks codes) and NCPDP reject codes (available with NCPDP membership) to indicate why a claim or line item was adjusted or denied. As of 01/01/2014 MHCP implemented CAQH CORE 360 Rule which is part of the ACA mandated CAQH CORE EFT & ERA Operating Rules.

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