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 data

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.

Reversals
- 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)
Denied
- Claims MHCP denied

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

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.

Reconciling charges

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.