Wis. ForwardHealth Online Handbook, Hospice, Topic #4829

The RA (Remittance Advice) information in the TXT (text) file includes the following sections:

• Address page

• Banner messages

• Paper check information, if applicable

• Claims processing information

• EOB (Explanation of Benefits) code descriptions

• Financial transactions

• Service code descriptions

• Summary

• Claim sequence numbers

The RA information in the CSV (comma-separated values) file includes the following sections:

• Payment

• Payment hold

• Service codes and descriptions

• Financial transactions

• Summary

• Inpatient claims

• Outpatient claims

• Professional claims

• Medicare crossovers— Professional

• Medicare crossovers— Institutional

• Compound drug claims

• Noncompound drug claims

• Dental claims

• Long term care claims

• Financial transactions

• Summary

• Claim sequence numbers

Providers can select specific sections of the RA in the CSV file within each RA date to be downloaded making the information

easy to read and to organize.

Remittance Advice Header Information

The first page of each section of the RA (except the address page of the TXT file) displays the same RA header information.

The following fields are on the left-hand side of the header:

• The technical name of the RA section (for example, CRA-TRAN-R), which is an internal ForwardHealth designation

• The RA number, which is a unique number assigned to each RA that is generated

• The name of the payer (Medicaid, HDAP (Wisconsin HIV Drug Assistance Program), WCDP (Wisconsin Chronic

Disease Program), or WWWP (Wisconsin Well Woman Program))

• The Pay To address of the provider. The Pay To address is used for mailing purposes.

The following information is in the middle of the header:

• A description of the financial cycle

• The name of the RA section (for example, Financial Transactions or Professional Services Claims Paid)

The right-hand side of the header reports the following information:

• The date of the financial cycle and date the RA was generated

• The page number

• The Payee ID of the provider. A payee ID is defined as the identification number of a unique entity receiving payment for

goods and/or services from ForwardHealth. The payee ID is up to 15 characters long and may be based on a pre-existing

identification number, such as the Medicaid provider number. The payee ID is an internal ForwardHealth designation. The

Medicaid provider number will display in this field for providers who do not have an NPI (National Provider Identifier).

• The NPI of the provider, if applicable. This field will be blank for those providers who do not have an NPI.

• The number of the check issued for the RA, if applicable

• The date of payment on the check, if applicable