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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.

Topic Brief Description
Reason Codes Used to 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
Medicare-Specific Remark Codes Used to 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 Remittance Advice remark code list
SPR Field Descriptions View SPR Field Headings and Descriptions
Reason Code Guidance View most common claim submission error codes, descriptions of issues and potential solutions
Electronic Remittance Advice (ERA) 835 This link takes you to an external website. Electronic version of SPR. Serves as a notice of payments and adjustments sent to providers, billers and suppliers. Explains reimbursement decisions of payer
Remittance Advice Remark Codes (RARCs) This link takes you to an external website. 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

Claim Adjustment Reason Code (CARCs) This link takes you to an external website.

Used to communicate an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed  

 

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Last Updated Oct 25, 2016