Wis. ForwardHealth Online Handbook, Hospice, Topic #4746

Cutback Fields on the Remittance Advice for Adjusted

and Paid Claims

Cutback fields indicate amounts that reduce the allowed amount of the claim. Examples of cutbacks include other insurance,

member copays, spenddown amounts, deductibles, or patient liability amounts. Amounts indicated in a cutback field are

subtracted from the total allowed reimbursement.

Providers should note that cutback amounts indicated in the header of an adjusted or paid claim section apply only to the header.

Not all cutback fields that apply to a detail line (such as copays or spenddowns) will be indicated on the RA (Remittance Advice);

the detail line EOB (Explanation of Benefits) codes inform providers that an amount was deducted from the total reimbursement

but may not indicate the exact amount.

Note: Providers who receive 835 (835 Health Care Claim Payment/Advice) transactions will be able to see all deducted amounts

on paid and adjusted claims.