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 service and paid amount. The RA also details any reductions to the paid amount, for reasons such as TPL and/or client copayment.
Each claim detail might have an explanation of benefit (EOB) code explaining the reason for payment, denial, adjustment or inprocess statuses. RAs are tailored to individual claim form types—1500, UB-04, Dental and Pharmacy.
When applicable, RAs include additional information, including procedure codes, revenue codes or admission and discharge dates for providers billing on the UB-04 claim form. The RA has several document types in this order:
- Check or EFT advice (if applicable).
- Address page.
- Banner messages (if applicable).
- Claims activity/status reports (if applicable).
- Ordered by claim type (Physician, Institutional, Dental, Pharmacy).
- Ordered by claim status (paid, denied, in process, adjusted).
- Financial transactions.
- Expenditures (system generated only).
- Cash receipts.
- Accounts receivable.
- TPL information (if applicable).
- EOB descriptions (if applicable).
- Summary report.
The RA is generated in each claim payment cycle. A provider will receive an RA if the provider has activity during the claim cycle or outstanding accounts receivable.
To learn more about HIPAA EDI and become a certified EDI Professional, please visit our course schedule page.