Name, address and telephone number of the Medicare contractor that processed the claim(s) and produced the Medicare Remittance Advice.
This is the remittance advice number or serial number. It is shown on all pages of each remittance advice.
Provider's name and address ('billing provider').
This area, boxed in with asterisks, contains contractor-specific information for the provider. The bulletin board section is only provided on the first page of the Medicare Remittance Advice.
The assigned claims section starts with a header row. This header row provides labels for the data displayed for each claim included on the remittance advice.
After the header row, claims are listed individually. Each claim starts with 'Name' in the upper left, and ends with 'NET', and an amount, in the lower right. A single line separates each claim. Beneficiary names are displayed on the Medicare Remittance Advice in alphabetical order by last name.
The first six fields apply to the claim as a whole (Name, HIC, ACNT, ICN, ASG, and MOA sections). Claim information is then broken out at a service-line level.
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This field contains the last name and first name of the patient for whom the claim was processed ('billing provider'). If a claim was submitted using the beneficiary name Jane Smith, but during processing Medicare records in the Common Working File (CWF) indicate the name of record for that patient is listed as Jane Jones, then the Medicare Remittance will display the name 'Jones, Jane' in this field.
This field indicates the Health Insurance Claim (HIC) number of the patient that received the services. For example, a claim was submitted by the provider using the HIC number 000000000A. If the patient's HIC number was changed to 000000000B in the Medicare eligibililty system, then the Medicare Remittance Advice will display HIC number 000000000B in this field.
This field contains any internal account number assigned to the claim by the provider, such as a patient account number, that was submitted on the claim.
The 13-digit ICN is a unique number assigned by Palmetto GBA to the claim at the time it is received. It is used to track and monitor the claim.
This field indicates whether the provider has accepted assignment for these claims. This field contains either a 'Y' for yes or an 'N' for no.
This field contains Remittance Advice Remark Codes (RARCs) or Claim Adjustment Reason Codes (CARC) at the claim level. These codes and their meanings are listed in the glossary section at the end of the Medicare Remittance Advice. RARCs and CARCs are used to convey appeal information and other claim-specific information providing additional explanation for claim-level adjustments. A complete listing of these codes is available at www.wpc-edi.com/codes.
This field displays the performing/rendering provider transaction access number (PTAN). If there is more than one performing provider, only the first is included.
The PTAN does not display on this remittance.
This field displays the date(s) of service.
This field indicates the two-digit Place of Service (POS) code.
This field displays how many services were submitted (number of units).
This field indicates the Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) procedure code submitted for the service.
This field displays all modifiers billed with the specified procedure/service.
This field displays the amount that the provider billed for the procedure/service.
This field displays the Medicare-allowed amount for the service.
This field displays the amount of any deductible applied to the service. If an amount is displayed in this field, this is the amount that the patient (or other insurer, if applicable) is responsible for paying the provider.
Some supplemental insurance plans may cover the deductible amount. NOTE: Deductible amounts are subject to change annually.
For 2010, the Part B deductible is $155.00 for the year.
For 2011, the Part B deductible is $162.00 for the year.
This field displays the coinsurance amount. If an amount is displayed in this field, this is the amount that the patient (or other insurer, if applicable) is responsible for paying the provider.
For Part B coinsurance, the patient is responsible for 20 percent of the allowed charges.
NOTE: Coinsurance amounts are subject to change annually.
Service Dates | Limitation % * | % Medicare Pays ** | % Patient Pays** |
---|---|---|---|
12/31/09 or before | 62.5% | 50% | 50% |
1/1/10 - 12/31/11 | 68.75% | 55% | 45% |
1/1/12 -12/31/12 | 75% | 60% | 40% |
1/1/13 - 12/31/13 | 81.25% | 65% | 35% |
1/1/14 and after | 100% | 80% | 20% |
* % of fee schedule amount **of the Limitation % |
This field contains any Group Codes and Claim Adjustment Reason Codes (CARCs) associated with this service line. There are four possible Group Codes for Medicare.
Codes listed for a service line of a claim are listed along with their definitions in the glossary section of the Medicare Remittance Advice. A complete listing of CARCs is available on this Web site: http://www.wpc-edi.com/codes.
CO-50
The AMT field contains the amount of any adjustment that was made based on the preceding Group Code and CARC.
The amount the provider is paid for this service.
This field contains any Remark Codes associated with this service line. Codes listed for a service line of a claim are listed along with their definitions in the glossary section of the Medicare Remittance Advice. A complete listing of CARCs is available on this Web site: http://www.wpc-edi.com/codes.
This field is reserved for HIPAA Version 5010.
This is the total amount (for the claim, including all service lines) that the patient (or other insurer, if applicable) is responsible for paying the provider.
This field displays the total amount that the provider submitted for the claim.
This field displays the total Medicare-allowed amount for all claims included on this remittance advice.
This field displays the total amount applied toward the patient's deductible for the entire claim.
For 2010, the Part B deductible is $155.00 for the year.
For 2011, the Part B deductible is $162.00 for the year.
This field displays the patient's coinsurance amount for the claim.
For Part B coinsurance, the patient is responsible for 20 percent of the allowed charges.
NOTE: Coinsurance amounts are subject to change annually.
Service Dates | Limitation % * | % Medicare Pays ** | % Patient Pays** |
---|---|---|---|
12/31/09 or before | 62.5% | 50% | 50% |
1/1/10 - 12/31/11 | 68.75% | 55% | 45% |
1/1/12 -12/31/12 | 75% | 60% | 40% |
1/1/13 - 12/31/13 | 81.25% | 65% | 35% |
1/1/14 and after | 100% | 80% | 20% |
* % of fee schedule amount **of the Limitation % |
This field contains the total amount of any adjustments that were made for the claim (including all service lines).
The amount the provider is paid for this claim.
The net amount the provider is being paid associated with this remittance advice. This total includes interest, if applicable
Number of claims included on this remittance advice.
The total billed charges included on this remittance advice.
This field displays the total Medicare-allowed amount for all claims included on this remittance advice.
This field displays the total amount applied toward the patient's deductible for all claims included on this remittance advice.
For 2010, the Part B deductible is $155.00 for the year.
For 2011, the Part B deductible is $162.00 for the year.
This field displays the patient's coinsurance amount for all claims included on tis remittance advice.
For Part B coinsurance, the patient is responsible for 20 percent of the allowed charges.
NOTE: Coinsurance amounts are subject to change annually.
Service Dates | Limitation % * | % Medicare Pays ** | % Patient Pays** |
---|---|---|---|
12/31/09 or before | 62.5% | 50% | 50% |
1/1/10 - 12/31/11 | 68.75% | 55% | 45% |
1/1/12 -12/31/12 | 75% | 60% | 40% |
1/1/13 - 12/31/13 | 81.25% | 65% | 35% |
1/1/14 and after | 100% | 80% | 20% |
* % of fee schedule amount **of the Limitation % |
This field indicates the total amount of adjustments made to assigned claims due to the Claim Adjustment Reason Codes (CARCs) listed on each service line. This excludes interest, late filing charges, deductibles, and amounts previously paid for rendered services.
The amount the provider is paid for all claims included on this remittance advice.
The amount of any adjustments made on all claims included on this remittance advice. The Group Codes and CARCs explain the reasons for any adjustments made.
The amount reflected on the check associated with this remittance advice.
Group, Reason, and Remark codes and their descriptions. Refer to this section for detailed explanations for any informational messages, denials, and adjustments. For detailed assistance with the most common denials, refer to the Palmetto GBA Denial Resolution Tool (accessible from the home page for your state except for Railroad Medicare).