Oklahoma Medicaid TPL Billing Procedures When submitting all claims, the amount paid by a third party must be entered in the appropriate field on the claim form or electronic transaction. If a third-party payer made payment, an explanation of payment (EOP), explanation of benefits (EOB), or remittance advice (RA) is not required for electronically submitted … Read More →
TPL Claim Processing Requirements (Oklahoma Medicaid) Providers are required to bill all other insurance carriers prior to billing the OHCA, except for programs that are secondary to the OHCA. The TPL Unit is available to assist with determining other insurance resources and maintaining the most current member TPL files. Billing Documentation Requirements The OHCA must … Read More →
Electronic Remittance Advice Transaction An electronic RA is available by using the X12 835 transaction as mandated under HIPAA. The 835 transaction is available to all OHCA providers and contracted trading partners that have requested electronic RAs. The 835 is a financial transaction that functions as an electronic means of posting accounts receivable. The 835 … Read More →
Remittance Advice (RA) (Oklahoma Healthcare Authority) OHCA providers receive a weekly remittance advice (RA) for any claims submitted the previous week. The RA identifies claims that are paid, denied, in process or adjusted. The RA includes the client ID number, the provider number, the Internal Control Number (ICN) of the claim processed, the date(s) of … Read More →