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52 11/2005
Remittance Advice Reconciliation
Remittance advices are sent to providers along with check payments. To ensure that
remittance advice information is accurately and completely posted to patient’s
accounts, reconciliation should be performed for each payment.
For questions concerning the remittance advice, please call the applicable
customer service department based on the patient’s plan coverage.
Charges denied as provider liability should be written-off to prevent an
overstatement of the accounts receivable balance.
If a denial pertains to a lack of medical necessity for an admission, a certain
procedure, or is rendered during the course of concurrent review, and you
disagree with the denial, see the Utilization Management Appeals process
for further information.
Members may not be billed for provider contractual allowances.
If you have any questions concerning contractual issues, contact your
regional senior network specialist.
Facsimiles of the remittance advice are shown on the following pages, with
explanations for the fields and column headings for each
Remittance Advice-Example 1
Remittance Advice-Example 2 (NASCO)