How to read your remittance advice (RA)
Minnesota Health Care Programs (MHCP) divides the remittance advice (RA) to health care providers into two parts: claims data (RA01) and supplemental data (RA02). This page explains the information on the PDF RA. Refer also to Remittance Advice (RA) Guide Chart (DHS-7400) (PDF).
Claims appear in the following order of claim status on the MHCP PDF RA. If a claim category was not adjudicated in the last payment cycle, it will not appear on the RA for that payment cycle.
- Claims that have been completely reversed
- Replacement claim take-backs (repayments appear under Paid Primary)
- Paid Primary
- Claims that MHCP paid as the primary (only) payer
- Replacement claim repayments (take-backs appear under Reversals)
- Paid Secondary
- Claims MHCP paid after coordination of benefits (COB) with one other payer, either Medicare or other health coverage (OHC)
- Paid Tertiary
- Claims MHCP paid after COB, with two or more other payers (Medicare, OHC)
MHCP sorts the claims within each claim status section in alphabetical order by the member’s last name. Providers may request one of the following other sort options:
- PMI number
- Provider’s own reference or patient account number
- Payer Claim Control Number (PCN)
Supplemental data is a separate document that consists of a list of any suspended claims and a Financial Summary Information page. Supplemental data is not a HIPAA-compliant transaction, cannot be sent with HIPAA-compliant information and is not included with the X12 835 RA transactions.
MHCP uses HIPAA-compliant adjustment codes available through the WPC website (Claim Status, Claim Status Category, Adjustment Group Reason and Remarks codes) and NCPDP reject codes (available with NCPDP membership) to indicate why a claim or line item was adjusted or denied. MHCP implemented CAQH CORE 360 Rule, which is part of the ACA mandated CAQH CORE EFT & ERA Operating Rules, in 2014.