How to Read the Paper Remittance Advice

Learn how to read and take action on the claim status information listed in this automated paper notice from DMAP.

• About the paper RA
• Quick references and tutorials
• Other ways to get claim status information

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About the paper RA

Information in the RA will appear in the following order, as applicable:

• Banner messages: Messages from DHS/OHA
• Paper check: If you don't want a paper check, sign up for direct deposit.
• 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 DMAP can process them. Learn how to read this section and your RA summary to find out how much you need to pay. 
• Summary: All activity reported to the RA
• EOB Code Descriptions: For all the Explanation of Benefit (EOB) codes listed in the RA

Quick references and tutorials

• Learn about the most common EOBs. This list shows whether the EOB is informational or if it requires action on your part.
• Learn how to read the paper RA. Also learn how to resolve underpayment or overpayments reported on the paper RA.
• The Pharmaceutical Services supplemental information lists EOBs crosswalked to NCPDP error codes.  

Other ways to get claim status information

These systems use HIPAA-compliant Claim Adjustment Reason Codes and/or Remittance Advice Remark Codes to describe the status of a claim.

• Automated Voice Response (866-692-3864) will read you information about the first six claims for the ICN or client ID you request claim status on. After that, you need to use the Provider Web Portal for additional information. For more information, refer to the AVR Quick Reference.
• The Provider Web Portal at https://www.or-medicaid.gov allows you to review and adjust, void or resubmit claims as necessary. For more information, view the Claim Adjustment Handbook and the step-by-step instructions.
• Electronic Remittance Advice (ERA or 835 transaction) – Through DMAP or a registered clearinghouse. Current electronic data interchange trading partners can sign up for the electronic RA (check the box for "835 Health Care Claim Payment/Advice"). Providers new to EDI can learn how to get started.