How to Read the Paper Remittance Advice

• How to read the RA
• Explanation of Benefit (EOB) codes
• What to do after you receive your RA
• Other ways to get claim status information

You will need the free Adobe Reader 6.0 or higher to view PDF documents. If you do not already have the latest version of the Adobe Reader on your computer, you can download it now.

____________________________________________________________________________________________

How to read the paper RA

View the tutorial (Powerpoint or PDF) for information about how to read the RA. Information in the RA will appear in the following order, as applicable: 

• Banner messages: Messages from DHS
• Claim information: By type of bill and Internal Control Number (ICN) - paid, denied, in process, adjustments
• Third-party liability (TPL) information: Third-party resources for each client, in order of ICN
• Financial transactions: Non-claim-specific payouts to or refunds from providers; accounts receivable information
• Leverage Claims Payable - Not paid: Lists the claims the providers must pre-pay before DHS can process them 
• Summary: All activity reported to the RA
• EOB Code Descriptions: For all the Explanation of Benefit (EOB) codes listed in the RA  

Explanation of Benefit (EOB) codes

The new system has more EOB messages, some of them informational that require no action on your part. Some are related to how your provider records are set up in the new system, which may require correction by Provider Enrollment and/or EDI Support Services. 

• The Top Billing Errors and Resolutions (PDF) lists the most common EOBs and how to resolve them.
• The RA and EDI Questions and Answers (PDF) includes information about EOBs related to MMIS conversion.
• Pharmacy providers: Refer to your supplemental information for a complete list of EOBs crosswalked to NCPDP error codes. 

What to do after you receive your RA

This slideshow (Powerpoint or PDF) tells you what to do when you receive an RA for underpaid, overpaid or denied claims.

Other ways to get claim status information

Enrolled providers can call Automated Voice Response (AVR) (866-692-3864) to obtain claim status by ICN or client ID. AVR will read you the first six claims for the ICN or client ID before referring you to the Provider Web Portal for additional information. For more information, refer to the AVR User Guide (PDF).

Enrolled providers can use the Claims Search on the Provider Web Portal at https://www.or-medicaid.gov to view all claims submitted to DHS, and adjust, void or resubmit claims as necessary. For more information, view the Web Adjustment Instructions and Claim Search tutorial on the Provider Web Portal information page.

For electronic claims and previously-submitted claims reviewed on the Provider Web Portal, HIPAA-compliant Claim Adjustment Reason Codes describe the status of the claim. A full list of these codes is available on the Washington Publishing Web site.