Remittance Advice (RA)/Electronic Remittance Advice (ERA) Payment Summary Page and Forward Balances (FB)
The “Payment Summary” page of the remittance advice (RA)/electronic remittance advice (ERA) may include a list of forward balances (FB) at the claim level. A FB occurs when a payment is recouped on a current or on a future RA/ERA, but the reimbursement amount is not enough to recover the recouped amount. The FB amount is the balance of what still needs to be recouped. For example, if the amount of $5000.00 needs to be recouped, but the total reimbursement made was only $3000.00, the remaining amount of $2000.00 will display as a FB on the “Payment Summary” page. The FB amount will then be recouped on future RAs/ERAs until it reaches a zero balance. The FB shown on the “Payment Summary” page identifies the document control number (DCN) and the health insurance claim (HIC) number of the claim which created the FB.
When the FB is withheld, the “Payment Summary” page will include a “withhold” (WO) line, along with the DCN of the claim and the HIC number indicating the corresponding FB being collected. The DCN on the WO line will correspond to the DCN on the claim that created the FB.
Note that the “Payment Summary” page will display three sets of columns. The following is an example of just one column.
The “Payment Summary” page should only be used as a tool to track forward balances. Do not use this page to balance your RA/ERA.
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