Remittance Advice (RA)
Once a claim has been processed, a Remittance Advice (RA) is issued in either Standard Paper Remittance (SPR) or Electronic Remittance Advice (ERA). An RA provides finalized claim details and contains explanatory claim processing message codes. Three different sets of codes are used on an RA: reason codes, group codes and Medicare-specific remark codes and messages.
Medicare-Specific Remark Codes - Convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a claim adjustment reason code. Each RA remark code identifies a specific message as shown in RA remark code list
Qualified Medicare Beneficiary (QMB) Program - View QMB program information and related remit advice remark codes.
Reason Codes - Explain why a claim was not paid or how claim was paid and provides reason for any claim financial adjustments, such as denials, reductions or increases in payment
WPC - Claim Adjustment Reason Code (CARCs) - Used to communicate an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed
WPC - Remittance Advice Remark Codes (RARCs) - Used to provide additional explanation for an adjustment already described by a CARC or to convey information about remittance processing. Each RARC identifies a specific message as shown in Remittance Advice Remark Code List
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 22 - Remittance Advice
Last Updated Oct 31, 2017