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Interactive Medicare Electronic Remittance Advice (ERA)

The Medicare Electronic Remittance Advice (ERA) is a notice sent to home health and hospice providers explaining how billing transactions are processed (paid, rejected, or denied). Billing transactions include final claims, adjustments, and canceled, denied, or rejected claims, as well as Requests for Anticipated Payments (RAPs). Medicare provides the PC-Print software for provider to view and print the ERA. Other software is available; however, the following information represents the view of the ERA using the PC-Print software. Providers are also able to view and print Medicare remittances using myCGS (the CGS Web portal). The following resource is available on the Centers for Medicare & Medicare Services (CMS) website.

Understanding Your Remittance Advice Reports

This interactive guide provides an overview of the ERA using PC-Print. Select the screen option (below) that you wish to view. As you move your mouse over the area of interest, the field(s) will highlight. Click on the area of interest to view more detailed information.

PC-Print offers four different options to display and print data.

All Claims (AC) screen provides information for multiple billing transactions at once. The AC screen will list billing transactions in alphabetical order by the beneficiary's last name.
Single Claim (SC) screen provides a detailed summary of a single billing transaction. An SC screen is available for each billing transaction listed on the AC screen.
Bill Type Summary (BS) screen provides a summary of billing transactions for each type of bill and for each fiscal year (FY) based on the billing transactions included in the ERA. For example, if there are home health claims processed with the type of bill 33X for FY18 and FY19, two separate bill type summary screens will be provided. One screen will display the FY18 claims and the other will display a summary of the FY19 claims.
Provider Payment Summary (PS) screen provides a summary of the payments made to billing transactions included in the ERA. In addition, this screen will show financial adjustment information, only if financial adjustments are made. For additional information, refer to the "Remittance Advice (RA)/Electronic Remittance Advice (ERA) Payment Summary Page and Forward Balances (FB)" article. For a complete list of Provider Level Adjustment Reason Codes, refer to the ASC X12N 835 Implementation Guide: Health Care Claim Payment/Advice available on the Washington Publishing Company website.

All Claims (AC) Screen

The All Claims (AC) screen provides information for multiple billing transactions at once. The AC screen will list billing transactions in alphabetical order by the beneficiary's last name.

As you move your mouse over the area of interest, the field(s) will highlight and the name of the field and more detailed information will display.

PATIENT NAME

Last name, first name (or first initial) and middle initial (if available) of the beneficiary for whom the billing transaction was processed. The AC screen lists claims in alphabetical order by the beneficiary’s last name.

PATIENT CNTRL NUMBER

Patient control number that was submitted on the billing transaction.

FRM DT

The start date of services on the processed billing transaction.

COST

Number of home health days used and applied to the Medicare Cost Report (MCR). This field does not apply to home health requests for anticipated payment (RAP) and hospice billing transactions.

REPTD CHGS

The dollar amount of charges submitted. For cancel billing transactions (type of bill XX8) and home health requests for anticipated payment (RAPs), this amount is negative.

SN DAYS

The number of covered skilled nursing (SN) units. This field is unique to PC Print version 2.01 or higher.

MS DAYS

The number of covered medical social (MS) worker units. This field is unique to PC Print version 2.01 or higher.

REIMB RATE

The per diem amount or percentage of reimbursement paid to a provider.

ALLOW/REIM

The allowable reimbursement amount for the covered services.

INTEREST

The interest amount paid to the provider for clean billing transactions that were not processed within the 30-day timeframe.

ICN NUMBER

Internal Control Number (ICN), also referred to as the Document Control Number (DCN) is a unique number assigned to the billing transaction when received by CGS.

MID

Beneficiary’s Medicare ID number for whom the billing transaction was processed.

THR DT

The last date of services on the processed billing transaction.

COVDV

The number of covered home health or hospice days or visits.

NCVD/DENIED

The number of non-covered home health or hospice days or visits.

PT DAYS

The number of covered physical therapy (PT) units. This field is unique to PC Print version 2.01 or higher.

NA DAYS

The number of nursing aide (NA) units. This field is unique to PC Print version 2.01 or higher.

MSP PRI PAYS

The Medicare Secondary Payer (MSP) Primary Payer amount when the primary insurance made payment on the billing transaction.

PROC CD AMT

For home health outpatient services (type of bill 34x), this is the total reimbursement amount for all covered services under the Medicare Physician Fee Schedule (MPFS). Not applicable to hospice billing transactions.

PAT REFUND

The beneficiary refund amount for billing transactions processed on this remittance advice.

CLAIM #

The claim number assigned by PC-Print software to each billing transaction printed on the remittance advice.

CLM STATUS

The status of the billing transaction when it completed processing. The following codes are used by Medicare.

1	Paid as primary
2	Paid as secondary
3	Paid as tertiary
4	Denied (this claim status shows when a claim is denied or rejected).
19	Medicare paid primary and the Medicare Administrative Contractor (MAC) sent the claim to another insurer.
20	Medicare paid secondary and the Medicare Administrative Contractor (MAC) sent the claim to another insurer.
21	Medicare paid tertiary and sent the claim to another insurer.
22	Adjustment to prior claim, reversal to previous payment (this claim status shows when a claim is cancelled (TOB XX8), including RAPs which have been auto-cancelled or cancelled by the provider.
23	Not a Medicare claim and the Medicare Administrative Contractor (MAC) sent claim to another insurer.

MEDICAL REC NUMBER

The medical record number that was submitted on the billing transaction.

NCVDV

This field will display the number of non-covered days or visits:

Submitted by the provider;
Partially denied by medical review; or
When home health partially denied services results in a Low Utilization Payment Adjustment (LUPA).

CLAIM ADJS

The claim level adjustment, such as a home health outlier payment.

ST DAYS

The number of covered speech-language pathology (ST) units. This field is unique to PC Print version 2.01 or higher.

COINS AMT

The coinsurance amount for which the beneficiary is responsible. Applicable to home health outpatient therapy claims (34X type of bill).

PROF COMP

This indicates whether a physician’s professional component was billed on the claim as part of a technical component.

LINE ADJ AMT

The total of line item adjusted amounts. For home health final claims, the amount is equal to the amount in the REPTD CHGS field. For paid request for anticipated payments (RAPs) and canceled RAPs and claims, the field shows a zero.

DEDUCTIBLES

The dollar amount applied to the beneficiary’s deductible. Applicable to home health outpatient therapy claims (34X type of bill).

NATIONAL PROVIDER ID

The National Provider Identifier (NPI) of the facility receiving the remittance advice.

MID CHG=X

This indicates whether the beneficiary’s Medicare ID number was changed during processing.
HN = No change to Medicare ID
C = MIC Change (Note the MID number in the MID field for future reference).

TOB=XXX

The Type of Bill (TOB) of the billing transaction (e.g., final claim, adjustment, canceled, denied, or rejected claim, and Request for Anticipated Payment (RAP).)

CV LN

The number of covered lines billed. When no payment is made on the billing transaction, this field will display a zero. For home health Requests for Anticipated Payment (RAPs), a zero will display. For home health final claims, the number of covered visits will display. For canceled claims, this field is a negative.

NCV L

This field will display the number of non-covered lines:

Submitted by the provider;
Denied by medical review; or
When the primary insurer paid more than what Medicare would have paid.

COVD CHGS

The dollar amount of covered charges.

NEW TCH/ECT

The dollar amount of the funds Medicare pays for ‘new technology’ drugs and devices.

SEQUESTRAIN

The 2 percent payment reduction on billing transactions with dates of service on or after April 1, 2013. The RC field on the remittance will include the Claim Adjustment Reason Codes (CARCs) 253 to explain the adjustment in payment.

ESRD AMT

This field indicates the ESRD Network Reduction amount. Not applicable to home health and hospice providers.

CONTR ADJ AMT

An adjustment resulting from a contractual agreement between the payer and payee. This amount reflects the difference between the billed amount and the net reimbursement, minus any other deductions (e.g., sequestration).

NET. REIMB

The net reimbursement for the total billing transactions processed on this remittance advice.

MARKED FOR PRINT

When Mark for Print is selected, a box displays that shows the number(s) of claim(s) that has/have been selected. Continue this process until all claims have been selected to print. Select File then Print Marked Items and the claims that were marked are printed.

PBP REDUCT

Population Based Payments (PBP) – Applies when provider agrees to participate in the Next Generation Accountable Care Organizations (ACO) Model.

ISLET

This field represents the amount associated with value code 'Q7' (ISLET Add-On Payment Amount).

PA REDUCT

Pennsylvania Rural Health Model (only applies to rural Pennsylvania hospitals).

Single Claim (SC) Screen

The Single Claim (SC) screen provides a detailed summary of a single billing transaction. An SC screen is available for each billing transaction listed on the AC screen.

As you move your mouse over the area of interest, the field(s) will highlight and the name of the field and more detailed information will display.

FPE

The provider Fiscal Period End (FPE).

PAID

The date of the remittance advice.

CLM#

The claim number assigned by the PC-Print software to each billing transaction printed on the remittance advice.

NPI

The National Provider Identifier (NPI) of the facility receiving the remittance advice.

TOB

The Type of Bill (TOB) of the billing transaction (e.g., final claim, adjustment, canceled, denied, or rejected claim, and Request for Anticipated Payment (RAP).)

PATIENT

Last name, first name (or first initial) and middle initial (if available) of the beneficiary for whom the billing transaction was processed.

PCN

Patient control number that was submitted on the billing transaction.

MID

Beneficiary’s Medicare ID number for whom the billing transaction was processed.

SVC FROM

The start date of services on the processed billing transaction.

MRN

The medical record number that was submitted on the billing transaction.

CLAIM STAT

The status of the billing transaction when it completed processing. The following codes are used by Medicare.

1	Paid as primary
2	Paid as secondary
3	Paid as tertiary
4	Denied (this claim status shows when a claim is denied or rejected).
19	Medicare paid primary and the Intermediary sent the claim to another insurer.
20	Medicare paid secondary and the Intermediary sent the claim to another insurer.
21	Medicare paid tertiary and sent the claim to another insurer.
22	Adjustment to prior claim, reversal to previous payment (this claim status shows when a claim is cancelled (TOB XX8), including RAPs which have been auto-cancelled or cancelled by the provider.
23	Not a Medicare claim and the Intermediary sent claim to another insurer.

THRU

The last date of services on the processed billing transaction.

ICN

Internal Control Number (ICN), also referred to as the Document Control Number (DCN) is a unique number assigned to the billing transaction when received by CGS.

REIM RATE

The per diem amount or percentage of reimbursement paid to a provider, depending on how the provider is reimbursed for an individual claim. Not applicable to home health and hospice billing transactions.

COINSURANCE

The dollar amount of coinsurance for which the beneficiary is responsible.

REPORTED

The dollar amount of charges submitted by the provider or that are covered by Medicare. For cancel billing transactions (type of bill XX8) and home health requests for anticipated payment (RAPs), this amount is negative.

HHA SN AMT

The dollar amount paid on a per visit basis for skilled nursing visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher.

MSP PRIM PAYER

The amount that the primary insurance paid for the services on the billing transaction.

NCVD/DENIED

The dollar amount of non-covered or denied charges.

HHA PT AMT

The dollar amount paid on a per visit basis for physical therapy visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher.

CASH DEDUCT

The dollar amount applied to the beneficiary’s deductible.

CLAIM ADJS

The claim level adjustment, such as a home health outlier payment.

HHA ST AMT

The dollar amount paid on a per visit basis for speech-language pathology visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher.

PAT REFUND

The dollar amount the provider owes the beneficiary for overpaid deductible and coinsurance.

LINE ADJ AMT

The total of line item adjusted amounts.

COVERED

The dollar amount of covered charges. If all services/visits are covered, this amount is the same as the amount in the REPORTED field.

HHA OT AMT

The dollar amount paid on a per visit basis for occupational therapy visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher.

PROC CD AMOUNT

The procedure code amount for billing transactions. Not applicable to home health and hospice billing transactions.

HHA MS AMT

The dollar amount paid on a per visit basis for medical social worker visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher.

ALLOW/REIM

The allowable reimbursement amount that the provider receives for the covered services.

COST REPT

The number of days used and applied to the Medicare Cost Report (MCR). This field does not apply to home health requests for anticipated payment (RAP) and hospice billing transactions.

HHA NA AMT

The dollar amount paid on a per visit basis for nurses aide visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher.

SEQUESTRAIN

COVD/UTIL

The number of covered days or visits. For home health requests for anticipated payment (RAPs), this field displays a zero. For home health final claims, this field displays the number of covered visits.

HSP ROUT CARE

The reimbursement amount for covered hospice routine home care units. This field is unique to PC Print version 2.01 or higher.

INTEREST

The dollar amount of interest paid by Medicare. Interest is paid on clean billing transactions that are not paid within the 30-day timeframe.

NON-COVERED

The number of non-covered days or visits.

HSP CONT CARE

The reimbursement amount for covered hospice continuous home care units. This field is unique to PC Print version 2.01 or higher.

CONTRACT ADJ

An adjustment resulting from a contractual agreement between the payer and payee.

COVD VISITS

The number of covered visits.

HSP GENERAL

The reimbursement amount for covered hospice general inpatient care units. This field is unique to PC Print version 2.01 or higher.

PBP REDUCT

Population Based Payments (PBP) – Applies when provider agrees to participate in the Next Generation Accountable Care Organizations (ACO) Model.

NCOV VISITS

The number of non-covered visits. For home health, this field displays the number of visits denied by medical review.

HSP RESPITE

The reimbursement amount for covered hospice respite care units. This field is unique to PC Print version 2.01 or higher.

PA REDUCT

Pennsylvania Rural Health Model (only applies to rural Pennsylvania hospitals).

HSP PHYS SVC

The reimbursement amount for covered hospice physician services. This field is unique to PC Print version 2.01 or higher.

NET REIM AMT

The net reimbursement amount received for this billing transaction.

HSP OTH

The reimbursement amount for other covered hospice units. This field is unique to PC Print version 2.01 or higher.

REMARK CODES

Remittance Advice Remark Codes (RARCs) that relay informational messages. A list of the latest codes is available at: http://www.wpc-edi.com/reference/codelists/healthcare/remittance-advice-remark-codes/.

REV

The specific revenue code for the individual service line.

DATE

This field indicates the date of service (MM/DD).

HCPCS

This field indicates the Healthcare Common Procedure Coding System (HCPCS) code, if applicable.

APC/HIPPS

This field indicates the Ambulatory Payment Classification (APC) and/or Health Insurance Prospective Payment System (HIPPS) code, if applicable.

MODS

This field displays modifiers for the individual service line, if applicable.

QTY

The number indicating how many services were billed per revenue code.

CHARGES

The billed amount for each individual service line.

ALLOW/REIM

The allowed amount or reimbursement amount for the individual service line, if applicable.

GC

The Group Code which identifies the financially responsible party or the general category of payment adjustment. A Claim Adjustment Reason Code (CARC) must accompany group codes. For additional information, refer to the Medicare Claims Processing Manual, Chapter 22, Section 130.1 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c22.pdf.

RSN

The Claim Adjustment Reason Code (CARC) for the individual service line, if applicable. A full list of CARCs may be found at http://www.wpc-edi.com/reference/ on the Washington Publishing Company (WPC) website.

AMOUNT

The amount of any adjustment to what was billed.

REMARK CODES

The Remittance Advice Remark Codes (RARCs) for the individual service line, if applicable. A full list of CARCs may be found at http://www.wpc-edi.com/reference/ on the Washington Publishing Company (WPC) website.

LICN

Line item control number.

HCPI

Healthcare Policy Identification.

SVC Desc

Service payment information.

Bill Type Summary (BS) Screen

The Bill Type Summary (BS) screen provides a summary of billing transactions for each type of bill and for each fiscal year (FY) based on the billing transactions included in the ERA. For example, if there are home health claims processed with the type of bill 33X for FY13 and FY14, two separate bill type summary screens will be provided. One screen will display the FY13 claims and the other will display a summary of the FY14 claims.

As you move your mouse over the area of interest, the field(s) will highlight and the name of the field and more detailed information will display.

FPE

The provider Fiscal Period End (FPE).

PAID

The date of the remittance advice.

CLM#

The number of claims for which the BS contains data.

NPI

The National Provider Identifier (NPI) of the facility receiving the remittance advice.

TOB

The Type of Bill (TOB) of the billing transaction (e.g., final claim, adjustment, canceled, denied, or rejected claim, and Request for Anticipated Payment (RAP).)

CHECK / EFT NUMBER

The check or Electronic Funds Transfer (EFT) transaction number through which payment was issued.

REIM RATE

The overall per diem amount or percentage of reimbursement paid to a provider, depending on how the provider is reimbursed for an individual claim. Not applicable to home health and hospice billing transactions.

REPORTED

The total dollar amount of charges on this ERA that were submitted by the provider with the type of bill shown in the TOB field.

DRG AMOUNT

The total Diagnostic Related Group (DRG) amount. Not applicable to home health and hospice billing transactions.

MSP PRIM PAYER

The total amount that the primary insurance paid for claims with this type of bill.

NCVD/DENIED

The total dollar amount of non-covered or denied charges for billing transactions on this ERA with the type of bill shown in the TOB field.

DRG/OPER/CAP

The total operating and capital Diagnostic Related Group (DRG) amount. Not applicable to home health and hospice billing transactions.

PROF COMPONENT

The total professional component amount for this type of bill.

CLAIM ADJS

The total dollar amount of claim level adjustment, such as a home health outlier payment, for billing transactions on this ERA with the type of bill shown in the TOB field.

LINE ADJ AMT

The total line adjustment amount for this type of bill. This amount is determined by totaling the amounts in the LINE ADJ AMT field on the All Claims (AC) screen for claims with this type of bill.

COVERED

The total dollar amount of covered charges for billing transactions on this ERA with the type of bill shown in the TOB field. This amount is the sum of the amounts shown in the COVD CHRGS field on the All Claims (AC) report with this type of bill.

OUTLIER

The total outlier amount paid for this type of bill. This field is the sum of the outlier amounts shown in the CLAIM ADJS field on the All Claims (AC) screen. Only applicable to home health billing transactions.

PROC CD AMOUNT

The total procedure code amount for this type of bill. Not applicable to hospice billing transactions.

CAP OUTLIER

The total outlier portions of Prospective Payment System (PPS) payments for capital. An amount shows in this field when an outlier was paid on one or more of the billing transactions processed on this ERA. Only applicable to home health billing transactions.

COST REPT

The number of days used and applied to the Medicare Cost Report (MCR). This field does not apply to home health requests for anticipated payment (RAP) and hospice billing transactions.

CASH DEDUCT

The total cash deductible amount for this type of bill. This amount is the sum of the amounts in the DEDUCTIBLES field on the All Claims (AC) screen. Applicable to home health outpatient therapy claims (34X type of bill).

PBP REDUCT

Population Based Payments (PBP) – Applies when provider agrees to participate in the Next Generation Accountable Care Organizations (ACO) Model.

COVD/UTIL

BLOOD DEDUCT

The total number of pints of blood applied to the beneficiary’s blood deductible. Not applicable to home health and hospice billing transactions.

INTEREST

The total amount of interest paid by Medicare for this type of bill. Interest is paid on clean billing transactions that are not paid within the 30-day timeframe.

NON-COVERED

The number of non-covered days or visits.

COINSURANCE

The total coinsurance amount for this type of bill. This amount is the sum of the amounts shown in the COINS AMT field on the All Claims (AC) screen.

CONTRACT ADJ

The total contractual adjustment amount. This amount is the sum of the amounts in the CONT ADJ AMT field on the All Claim (AC) screen for this type of bill.

COVD VISITS

The number of covered visits.

PAT REFUND

The total beneficiary refund amount for this type of bill. This amount is the sum of the amounts shown in the PAT REFUND field on the All Claims (AC) screen.

PER DIEM AMT

The total per diem for this type of bill. Not applicable to hospice billing transactions.

NCOV VISITS

The number of non-covered visits. For home health, this field displays the number of visits denied by medical review.

SEQUESTRATN

PA REDUCT

Pennsylvania Rural Health Model (only applies to rural Pennsylvania hospitals).

NET REIM AMT

The total net reimbursement amount for this type of bill. This amount is the total of amounts in the NET REIMB field on the All Claims (AC) screen for this type of bill.

Provider Payment Summary (PS) Screen

The Provider Payment Summary (PS) screen provides a summary of the payments made to billing transactions included in the ERA. In addition, this screen will show financial adjustments information, only if financial adjustments have been made. For additional information, refer to the "Remittance Advice (RA)/Electronic Remittance Advice (ERA) Payment Summary Page and Forward Balances (FB)" article.

As you move your mouse over the area of interest, the field(s) will highlight and the name of the field and more detailed information will display.


NPI The National Provider Identifier (NPI) of the facility receiving the remittance advice.
CHECK / EFT NUMBER The check or electronic funds transfer number.

PAYMENT TOTAL The net reimbursement for the billing transactions processed on this remittance advice.	BILLING CYCLE The date that the billing transactions on this remittance advice were paid.
TOTAL CLAIMS The total number of billing transactions included on this remittance advice.	TOTAL PIP CLAIMS The total number of billing transactions processed under the Periodic Interim Payment (PIP). *Not applicable to home health and hospice providers.*

		FINANCIAL ADJUSTMENTS Financial Adjustments will only display when financial adjustments have been made. For additional information, refer to the “Remittance Advice (RA)/Electronic Remittance Advice (ERA) Payment Summary Page and Forward Balances (FB)” article.

Payer Business Contact Information Telephone Telephone Extension Facsimile Electronic Mail Payer Technical Contact Information Telephone Extension Facsimile Electronic Mail Uniform Resource Locator (URL) The business and technical contact information for CGS.