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

Denial Code Resolution - View common claim submission error codes, descriptions of issues, and potential solutions

Reason Codes - Explain why a claim was not paid or how claim was paid. Also show reason for any claim financial adjustments, such as denials, reductions or increases in payment

SPR Field Descriptions - View SPR field headings and descriptions

EDISS - Electronic Remittance Advice (ERA) 835 - Electronic version of SPR. Serves as a notice of payments and adjustments sent to providers, billers and suppliers. Explains reimbursement decisions of payer

X12 - 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

X12 - 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



Last Updated Aug 07 , 2023