Medicare Remittance Advice - JA DME

Suppliers are notified of the claim determinations on all claims. The notification is provided through a Medicare Remittance Advice or Standard Paper Remittance (SPR), which includes information on one or more claims. The notices are mailed daily; therefore, notification is received shortly after the claims are processed. Checks are included with the remittance advice if the claim determination is for an approved payment when the supplier has not signed up for direct deposit of Medicare payment.

Suppliers should retain all original remittance advices in their records as they provide valuable facts regarding their claims. There may be occasions in the future when suppliers will need to refer to an earlier remittance advice.

The claims will be listed in alphabetical order by the beneficiary's last name. The Medicare ID and Internal Control Number (ICN) [also referred to as the Claim Control Number (CCN)] are on the same line as the beneficiary's name. The ICN number will be different for every claim. These numbers are important when calling or writing to the DME MACs.

Claim Control Numbers

The Claim Control Number (CCN) is an individual 14-digit number given to each claim when entered the Medicare system. The first five digits indicate the date (in Julian date format) Medicare received the claim. The Julian date will equal the first two digits of the year and the next three digits are the sequential numbering of the days of the year (March 23, 2007 will show 07083). The sixth digit indicates whether the claim was submitted electronically or paper. The final digit indicates whether the claim is an initial or adjusted claim. A final number of 1 or higher shows the claim has been adjusted.

Special attention should be made to the claim remarks and American National Standard Institute (ANSI) codes. The claim remarks are listed at the end of the first line in the MOA field with an explanation of each code at the bottom of the remittance. The ANSI codes are listed at the end of each line item prefaced by a group code (CO, PR, or OA). Explanations for the ANSI code and the Group code will be listed at the bottom of the remittance advice. The codes will explain the basis for payment, reason(s) for denial and other pertinent claim information.

CMS mandated the discontinuation of SPRs effective June 1, 2006, for suppliers who are also set up to receive Electronic Remittance Advices (ERAs). As a result, if a DME supplier is enrolled for ERNs and has been activated for this service for 45 days or more, they are no longer receiving the SPR and must rely solely on downloading the ERN files from this date forward. This is true whether the ERA is received directly or through a billing agent, clearinghouse, or other entity representing the company. For more information on the discontinuation of SPRs, see Change Request (CR) 4376.

Duplicate Remittance Advice

If a provider has a need for a duplicate remittance advice, they may request one on an individual claim basis or for all the claims associated with one check. The upper right hand corner statement on a duplicate remittance advice is modified to read, "Medicare Duplicate Notice." The CHECK AMT on a duplicate remittance advice will always read $0.00 (even when the original remit showed a payment amount).

If a duplicate remittance advice is requested for a single check, the date shown on the remittance advice will be the date the original remittance advice was printed. However, if multiple remittance advices are requested, they will be mailed together, and the original date of the remittance advice will not display. In this situation, the date in which the duplicate remittance advices were produced will display.

The date shown on the remittance advice for a single claim will be the date of the original remittance advice. However, if a provider requests duplicate remittance advice for multiple claims, the date in which the duplicate remittance advices are produced will display.