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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

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Interactive Medicare Standard Paper Remittance (SPR) Advice

Interactive Medicare Standard Paper Remittance (SPR) Advice

The Medicare Remittance Advice (RA) 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). SPRs are not provided if the HH&H has received the Electronic Remittance Advice (ERA) for more than 30 days. However, providers who have registered for myCGS (the CGS Web portal) are able to view and print standard paper remittances.

This interactive guide provides an overview of the SPR Advice. Select the section (below) that you wish to view. As you move your mouse over the area of interest, the field(s) will highlight and the name of the field will display. Click on the field to view more detailed information.

The SPR includes two sections:

  • All Claims (AC) page(s) show information for each individual claim (not the individual charges on the claim). Claims will be listed on separate pages depending on whether the services apply to Medicare Part A or Part B.
  • Summary page includes information that encompasses all the claims included in the AC section. 


All Claims (AC) Page

The All Claims (AC) page includes information for each individual claim (not the individual charges on the claim). Claims will be listed on separate pages depending on whether the services apply to Medicare Part A or Part B.

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

AC_r001001

Medicare Administrative Contractor (MAC) Information
General information about CGS, your Medicare Administrative Contractor (MAC) who processed the claims and distributed the SPR. This information appears on the top of every page.

AC_r002001

Provider Information
General information about the Medicare provider, which includes the provider's National Provider Identifier (NPI), name, and address.

AC_r003001

Miscellaneous Information
The section of the SPR will identify whether the claims listed apply to Medicare Part A or Part B. Claims for Part A and Part B will appear on separate pages of the SPR. This section also provides the date the claims were paid, a unique SPR number (REMIT#), and the page number.

AC_r004001
AC_r005001

Patient Name
Last name, first name (or first initial) and middle initial (if available) of the beneficiary for whom the billing transaction was processed. Billing transactions will display in alphabetical order by the beneficiary's last name.

  AC_r005003

PATIENT CNTRL NUMBER
Patient control number that was submitted on the billing transaction.

AC_r005004

Claim Adjustment Reason Codes (CARCs) provide information about an adjustment and explain why a billing transaction or service line was paid differently than it was billed. A list of the latest codes is available at http://www.wpc-edi.com/reference/codelists/healthcare/claim-adjustment-reason-codes/.

  • CARC 45 will display on home health final claims subject to the outlier limitation.
  • CARC 253 indicates a reduction in payment due to sequestration
AC_r005005

Remittance Advice Remark Codes (RARCs) provides further explanation of an adjustment already described by the code in the RC field. It is also used to relay informational messages. A list of the latest codes is available at: http://www.wpc-edi.com/reference/codelists/healthcare/remittance-advice-remark-codes/

AC_r005006

The Diagnosis Related Group (DRG) number assigned to the billing transaction. Not applicable to home health and hospice billing transactions.

AC_r005007

The outlier payment that was made in addition to the DRG payment (if applicable). Not applicable to home health and hospice billing transactions.

AC_r005008

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

AC_r005009

The dollar amount that the provider owes the beneficiary for overpaid deductible and coinsurance. Not applicable to home health and hospice billing transactions.

AC_r005010

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).

AC_r006001

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

  AC_r006003

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.

  AC_r006005

An outlier code indicates a cost outlier was paid to a hospital provider.

AC_r006006

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

AC_r006007

The dollar amount of Medicare covered charges.

AC_r006008

The End-Stage Renal Disease (ESRD) Network Reduction amount. Not applicable to home health and hospice billing transactions.

AC_r006009

The dollar amount for which the patient is responsible.

AC_r007001

The beginning and ending dates on the processed billing transaction.

AC_r007002

The beginning and ending dates on the processed billing transaction.

  AC_r007004

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).)

AC_r007005

The physician's professional component billed on the billing transaction.

AC_r007006

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

AC_r007007

The dollar amount of charges that are not covered by Medicare.

AC_r007008

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

AC_r007009

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.

AC_r008001

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.

  AC_r008003

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.

AC_r008004

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

AC_r008005

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

AC_r008006

The dollar amount associated with the adjusted DRG code.
Not applicable to home health and hospice billing transactions.

AC_r008007

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

AC_r008008

The dollar amount of denied charges. When charges are denied for reasons other than Medical Review, refer the Claim Adjustment Reason Code (CARC) in the RC field and/or the Remittance Advice Remark Codes (RARC) in the REM field for more information.

AC_r008009

Indicates a presumptive payment adjustment on a billing transaction.

AC_r008010

The net reimbursement for each billing transaction.

AC_r009001

Medicare Beneficiary Identifier

  AC_r009003

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.

 
  AC_r010001

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

AC_r011001

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

PH1
AC_r012001
AC_r013001

Billing transactions are grouped by Fiscal Year. If multiple FYs are present on a single remittance advice, a FY subtotal displays after each group of billing transactions.

AC_r014001

Billing transactions for Part A and Part B services will appear on separate pages of the remittance advice, with respective subtotals.



Summary Page

The Summary page includes information that encompasses all the claims included in the AC section.

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

SUM_r001001

Medicare Administrative Contractor (MAC) and Provider Information
General information about CGS, your Medicare Administrative Contractor (MAC) who processed the claims and distributed the SPR. This information appears on the top of every page. General information about the Medicare provider follows, which includes the provider's National Provider Identifier (NPI), name, and address.

SUM_r002001

The CLAIM DATA section of the summary page displays totals for all the billing transactions references on this SPR.

SUM_r002002

This section of the summary page contains Pass through amounts. These fields do not apply to home health and hospice billing transactions.

 
  SUM_r003001

Not functional.

SUM_r003001b

This section of the summary page displays all provider payments made on this SPR and can be used for transaction-level balancing. To obtain the total payment amount (NET PROVIDER PAYMENT), add all the amounts in the PAYMENTS section. Then subtract the amount shown in the TOTAL WITHHOLD field, which is a negative amount representing the total of all provider adjustments.

SUM_r004001

Heading for the COST, COVDY and NCOVDY information.

SUM_r004002

Not functional

 
SUM_r005001

Summary of the total number of days applied to the Medicare Cost Report (MCR) for billing transactions processed on this SPR. Not applicable to home health and hospice billing transactions.

SUM_r005002

An additional payment made to a hospital for services provided by an intern or resident physician. Not applicable to home health and hospice billing transactions.

SUM_r005003

Heading for the payment recap section of the summary page.

SUM_r006001

Summary of covered home health or hospice days or visits for billing transactions processed on this SPR.

SUM_r006002

An additional payment amount made to a certified hospital for a kidney acquisition. Not applicable to home health and hospice billing transactions.

SUM_r006003

The total DRG outlier amount for billing transactions processed on this SPR. Not applicable to home health and hospice billing transactions.

SUM_r007001

Summary of non-covered home health or hospice days for billing transactions processed on this SPR.

SUM_r007002

The dollar amount of reimbursable bad debts. These debts include coinsurance and deductibles that a hospital is unable to collect from a beneficiary. Not applicable to home health and hospice billing transactions.

SUM_r007003

The total amount of interest paid by Medicare for billing transactions processed on this SPR.  Interest is paid on clean billing transactions if Medicare payment is not made within 30 calendar days. Reference: Medicare Claims Processing Manual, Pub. 100-04, Ch. 1, Section 80.2.2

  SUM_r008001

The reimbursement amount a hospital receives for Certified Registered Nurse Anesthetist (CRNA) services. Not applicable to home health and hospice billing transactions.

SUM_r008002

The total procedure code payable amounts for billing transactions processed on this SPR. Not applicable to home health and hospice billing transactions.

SUM_r009001

Heading for the COVD, NCOVD and DENIED information.

SUM_r009002

A total of the pass thru amounts in the Pass Thru Amounts section of the SPR. Not applicable to home health and hospice billing transactions.

SUM_r009003

The total net reimbursement amount made to the provider for billing transactions processed on this SPR.

SUM_r010001

Summary of covered charges for billing transactions processed on this SPR.

  SUM_r010002

A total of the pass thru amounts in the Pass Thru Amounts section of the SPR. Not applicable to home health and hospice billing transactions.

SUM_r011001

Summary of non-covered charges for billing transactions processed on this SPR.

SUM_r011002

The dollar amount of the Periodic Interim Payment (PIP) paid to the provider. Not applicable to home health billing transactions.

SUM_r011003

The dollar amount of the Periodic Interim Payment (PIP) paid to the provider. Not applicable to home health billing transactions.

SUM_r012001

Summary of denied charges for billing transactions processed on this SPR.

SUM_r012002

The refund amount issued for settlement payments.

SUM_r012003

The refund amount issued for settlement payments.

    SUM_r013002

The dollar amount of an accelerated payment made to a provider.

  SUM_r035001

Indicates refunds unrelated to settlement payments.

SUM_r035002

Indicates refunds unrelated to settlement payments.

SUM_r014001

Summary of the professional component amount for billing transactions processed on this SPR.

SUM_r014002

The dollar amount of money being released previously withheld from a provider on penalty withhold.

SUM_r014003

The dollar amount of money being released previously withheld from a provider on penalty withhold.

SUM_r015001

Summary of MSP payment made for billing transactions processed on this SPR.

SUM_r015002

The amount of a Transitional Outpatient Payment. Not applicable to home health and hospice billing transactions.

SUM_r015003

The total TOP amount paid on this SPR. Not applicable to home health and hospice billing transactions.

SUM_r016001

Summary of deductible payments owed to the provider by beneficiaries for billing transactions processed on this SPR.
Applicable to home health outpatient therapy billing transactions (34X type of bill).

SUM_r016002

An additional payment amount an inpatient hospital receives for the hemophilia blood-clotting factor. Not applicable to home health and hospice billing transactions.

SUM_r016003

The total hemophilia add-on amount paid on this SPR. Not applicable to home health and hospice billing transactions.

SUM_r017001

Summary of the coinsurance amount owed to the provider by beneficiaries for billing transactions processed on this SPR.
Applicable to home health outpatient therapy billing transactions (34X type of bill).

SUM_r017003

An additional dollar amount Medicare paid for 'new technology' drugs and devices. Not applicable to home health and hospice billing transactions.

SUM_r017003b

The total dollar amount of funds Medicare paid for 'new technology' drugs and devices on this SPR. Not applicable to home health and hospice billing transactions.

  SUM_r018001

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

SUM_r018002

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

  SUM_r019001

The amount of a check/payment that has been voided and reissued. Not applicable to home health and hospice billing transactions.

SUM_r019002

The total amount of a check/payment that has been voided and reissued on this SPR.

  SUM_r020001

Not applicable for home health and hospice services

SUM_r020002

Not applicable for home health and hospice services

    SUM_r021001

The outstanding balance owed to Medicare that is carried forward to the next SPR. For additional information, refer to the "Remittance Advice (RA)/Electronic Remittance Advice (ERA) Payment Summary Page and Forward Balances (FB)" article on the CGS website.

SUM_r024001

Summary of the beneficiary refund amount for billing transactions processed on this SPR.

SUM_r024002

This section of the summary page includes the amount(s) withheld from payments.

SUM_r024003

The total amount withheld for billing transactions processed on this SPR. This amount is the sum from the WITHHOLD FROM PAYMENTS section of the SPR.

SUM_r025001

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

SUM_r025002

The amount withheld from the current SPR's net reimbursement and applied to an existing claim receivable balance. The claim receivable balance would have been created and carried forward from a net negative reimbursement on a previous SPR. A net negative reimbursement is usually caused by a cancellation or adjustment to a previous paid billing transaction. When the net negative reimbursement exceeds total payments, a claim receivable balance carries forward and offsets future payments. CGS recommends that you monitor negative net reimbursement totals on SPRs in order to identify the claim receivable withholdings that are recouped on future SPRs.

SUM_r025003

This amount displays when forced balancing of the SPR is required.

SUM_r026001

Summary of the contractual adjustment amount for billing transactions processed on this SPR.

SUM_r026002

The dollar amount being withheld to recover an accelerated payment previously paid to the provider.

SUM_r026003

The net amount being paid to the provider. This amount should match the check amount issued to the provider.

SUM_r027001

Summary of the procedure code payable amount for billing transactions processed on this SPR.
Not applicable to home health and hospice billing transactions.

SUM_r027002

The payment amount withheld from a provider due to an unfiled Medicare Cost Report, a payment suspension or a credit balance report not being submitted in a timely manner.

SUM_r027003
SUM_r028001

The total dollar amount that a provider receives for billing transactions included on this remittance advice.

SUM_r028002

The dollar amount withheld from a provider due to an unpaid settlement owed to Medicare.

SUM_r028003

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

  SUM_r029001

The dollar amount withheld from a provider due to a third party payment.

 
  SUM_r030001

The payment amount withheld from an affiliated provider.

 
  SUM_r031001

The payment amount withheld from a provider due to a recoupment owed to Medicare.

 
  SUM_r032001

The payment amount withheld from a provider due to overdue taxes owed to the Internal Revenue Service (IRS).

 
  SUM_r033001

The payment amount withheld from a provider due to unpaid debts. Typically, these withholdings are Treasury requested offsets for unpaid Medicare or VA overpayments of the provider or an affiliated providers.

 
  SUM_r034001

A total of the withholding amounts in the Withhold From Payments section of the SPR.

 

Updated: 11.16.20

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