Wis. ForwardHealth Online Handbook, Hospice, Topic #4418

Remittance Advice

Address Page

In the TXT (text) file, the Address page displays the provider name and "Pay to" address of the provider.

Banner Messages

Claim Types Provider Types

Dental claims Dentists, dental therapists, dental hygienists, HealthCheck agencies that provide dental services

Inpatient claims Inpatient hospital providers and institutes for mental disease providers

Long term care claims Nursing homes

Medicare crossover

institutional claims

Most providers who submit claims on the UB-04

Medicare crossover

professional claims

Most providers who submit claims on the 1500 Health Insurance Claim Form ((02/12))

Noncompound and

compound drug claims

Pharmacies and dispensing physicians

Outpatient claims Outpatient hospital providers and hospice providers

Professional claims Ambulance providers, ambulatory surgery centers, anesthesiologist assistants, audiologists, case

management providers, certified registered nurse anesthetists, chiropractors, community care

organizations, community support programs, crisis intervention providers, day treatment providers,

family planning clinics, federally qualified health centers, HealthCheck providers, HealthCheck Other

Services providers, hearing instrument specialists, home health agencies, independent labs, individual

medical supply providers, medical equipment vendors, mental health/substance abuse clinics, nurses in

independent practice, nurse practitioners, occupational therapists, opticians, optometrists, personal

care agencies, pharmacists, physical therapists, physician assistants, physician clinics, physicians,

podiatrists, portable X-ray providers, prenatal care coordination providers, psychologists,

rehabilitation agencies, respiratory therapists, rural health clinics, school-based services providers,

specialized medical vehicle providers, speech and hearing clinics, speech-language pathologists,

therapy groups

The Banner Messages section of the RA (Remittance Advice) contains important, time-sensitive messages for providers. For

example, banner messages might inform providers of claim adjustments initiated by ForwardHealth, claim submission deadlines,

and dates of upcoming training sessions. It is possible for each RA to include different messages; therefore, providers who receive

multiple RAs should read all of their banner messages.

Banner messages appear on the TXT file but not on the CSV (comma-separated values) file. Banner messages are posted in the

"View Remittance Advices" menu on the provider's secure Portal account.

Explanation of Benefits Code Descriptions

EOB (Explanation of Benefits) code descriptions are listed in the RA information in the TXT file.

EOB codes are listed in the RA information from the CSV file; however, the printed messages corresponding to the codes do not

appear in the file.

Financial Transactions Page

The Financial Transactions section details the provider's weekly financial activity. Financial transactions reported on the RA

include payouts, refunds, accounts receivable, and payments for claims.

Payouts are payments made to the provider by ForwardHealth that do not correspond to a specific claim (that is, nursing home

assessment reimbursement).

Refunds are payments made to providers for overpayments.

The Accounts Receivable section displays the accounts receivable for amounts owed by providers. The accounts receivable is set

to automatically recover any outstanding balance so that money owed is automatically recouped from the provider. If the full

amount cannot be recouped during the current financial cycle, an outstanding balance will appear in the "Balance" column.

In the Accounts Receivable section, the "Amount Recouped In Current Cycle" column, when applicable, shows the recoupment

amount for the financial cycle as a separate number from the "Recoupment Amount To Date." The "Recoupment Amount To

Date" column shows the total amount recouped for each accounts receivable, including the amount recouped in the current cycle.

The "Total Recoupment" line shows the sum of all recoupments to date in the "Recoupment Amount To Date" column and the

sum of all recoupments for the current financial cycle in the "Amount Recouped In Current Cycle" column.

For decreasing claim adjustments listed on the RA, a separate accounts receivable will be established and will be listed in the

Financial Transactions section. The accounts receivable will be established for the entire amount of the original paid claim.

Providers will see net difference between the claim and the adjustment reflected on the RA.

Each new claim adjustment is assigned an identification number called the "Adjustment ICN (internal control number)." For other

financial transactions, the adjustment ICN is determined by the following formula.

Type of Character and Description Applicable Characters and Description

Transaction— The first character indicates the type of financial

transaction that created the accounts receivable.

V— Capitation adjustment

1— OBRA Level 1 screening void request

2— OBRA Nurse Aide Training/Testing void request

Identifier— 10 additional numbers are assigned to complete the

Adjustment ICN.

The identifier is used internally by ForwardHealth.

Service Code Descriptions

The Service Code Descriptions section lists all the service codes (that is, procedure codes or revenue codes) reported on the RA

with their corresponding descriptions.

Summary

The Summary section reviews the provider's claim activity and financial transactions with the payer (Medicaid, HDAP (Wisconsin

HIV Drug Assistance Program), WCDP (Wisconsin Chronic Disease Program), or WWWP (Wisconsin Well Woman Program))

for the current financial cycle, the month-to-date, and the year-to-date, if applicable.

Under the "Claims Data" heading, providers can review the total number of claims that have been paid, adjusted, or denied along

with the total amount reimbursed for all paid and adjusted claims. Only WWWP providers will see amounts reported for "Claims

in Process." Other providers will always see zeroes in these fields.

Under the "Earnings Data" heading, providers will see total reimbursement amounts for other financial transactions, such as

reimbursement for OBRA (Omnibus Budget Reconciliation Act of 1987) Level 1 screening, reimbursement for OBRA Nurse Aid

Training/Testing, and capitation payments.

Note: HMOs should note that capitation payments are only reported in the Summary section of the RA. HMOs receive

supplemental reports of their financial transactions from ForwardHealth.

The "Earnings Data" portion also summarizes refunds and voids and reports the net payment for the current financial cycle, the

month-to-date, and the year-to-date, if applicable.

Providers should note that the Summary section will include outstanding checks 90 days after issuance and/or payments made to

lien holders, if applicable.