New York State Electronic Medicaid System Remittance-Books Pdf

New York State Electronic Medicaid System Remittance
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TABLE OF CONTENTS,TABLE OF CONTENTS,1 Purpose Statement 4. 2 Remittance Advice Formats 5,2 1 Electronic HIPAA 835 820 Transaction 5. 2 2 PDF Remittance Advice 6,2 3 Paper Remittance Advice 6. 2 3 1 Remittance Sorts 6,3 Paper PDF Remittance Advice Sections 7. 3 1 Section One Medicaid Check 8,3 1 1 Medicaid Check Stub Field Descriptions 9.
3 1 2 Medicaid Check Field Descriptions 9,3 2 Section One EFT Notification 10. 3 2 1 EFT Notification Page Field Descriptions 11,3 3 Section One Summout No Payment 12. 3 3 1 Summout No Payment Field Descriptions 12,3 4 Section Two Provider Notification 13. 3 4 1 Provider Notification Field Descriptions 14,3 5 Section Three Claim Detail 15. 3 5 1 Child Care Claim Detail 16,3 5 2 Clinic APG Claim Detail 24.
3 5 3 Claim Detail Page Field Descriptions 27,3 5 4 Dental Claim Detail 32. 3 5 5 DME Claim Detail 40,3 5 6 Home Health Claim Detail 48. 3 5 7 Inpatient Claim Detail 57,3 5 8 Nursing Home Claim Detail 66. 3 5 9 Pharmacy Claim Detail 75,3 5 10 Practitioner Claim Detail 83. 3 5 11 Transportation Claim Detail 93,REMITTANCE ADVICE.
Version 2013 01 7 31 2013,Page 2 of 108,CLAIMS SUBMISSION. 3 6 Section Four Financial Transactions and Accounts Receivable 101. 3 6 1 Financial Transactions 101,3 6 2 Accounts Receivable 103. 3 7 Section Five Edit Error Description 105,4 The Status of Claims 106. For eMedNY Billing Guideline questions please contact. the eMedNY Call Center 1 800 343 9000,REMITTANCE ADVICE. Version 2013 01 7 31 2013,Page 3 of 108,PURPOSE STATEMENT.
1 Purpose Statement, The purpose of this document is to familiarize the provider with the contents of the Remittance Advice. Remittance advices contain the following information. A listing of all claims identified by several pieces of information as submitted on the claim that have entered. the computerized processing system during the corresponding cycle. The status of each claim deny paid pend after processing. The eMedNY edits errors failed by pending or denied claims. Subtotals and grand totals of claims and dollar amounts. Other financial information such as recoupments negative balances etc. The remittance advice in addition to showing a record of claim transactions and assisting providers in identifying and. correcting billing errors plays an important role in the communication between the provider and the eMedNY. Contractor for resolving billing or processing issues. REMITTANCE ADVICE,Version 2013 01 7 31 2013,Page 4 of 108. PAPER REMITTANCE ADVICE SECTIONS,2 Remittance Advice Formats. Providers may receive remittance advice information in one of three formats. The electronic HIPAA 835 820 transaction,PDF Remittance Advice. Paper Remittance Advice, Remittance Advices contain a maximum of ten thousand 10 000 claim lines any overflow will generate a separate 835.
and a separate check, Providers who submit claims under multiple ETINs will receive a separate remittance advice for each ETIN regardless of. advice format,2 1 Electronic HIPAA 835 820 Transaction. The electronic HIPAA 835 820 transaction Remittance Advice is available via the eMedNY eXchange or FTP For. institutional providers retro adjustment information is also sent in the 835 820 transaction format Pending claims are. listed in the Supplemental file that is delivered with the 835 820. To request the electronic remittance advice providers must complete the Electronic Remittance Request Form which is. available at www emedny org by clicking on the link to the web page as follows Electronic Remittance Request Form. Providers with only one ETIN receiving an electronic remittance will have the status of any claims submitted via paper. forms state submitted adjustments voids and Medicare Crossover claims reported on that electronic remittance The. Default Electronic Transmitter Identification Number ETIN Selection Form is available on emedny org by clicking on the. link Default ETIN Selection Form, Providers with multiple ETINs who receive the 835 820 electronic remittance advice may elect to receive the status of. paper claim submissions state submitted adjustments voids and Medicare Crossover claims in the 835 format The. request must be submitted using the Default ETIN Selection Form which is available at www emedny org by clicking on. the link to the web page as follows Default ETIN Selection Form. Further information on the 835 transaction is available at www emedny org by clicking on the link to the web page that. follows eMedNY Transaction Information Standard Companion Guide CAQH CORE CG X12. For additional information providers may also call the eMedNY Call Center at 800 343 9000. REMITTANCE ADVICE,Version 2013 01 7 31 2013,Page 5 of 108. PAPER REMITTANCE ADVICE SECTIONS,2 2 PDF Remittance Advice.
The PDF Remittance Advice may be received electronically via the eMedNY eXchange or FTP and may opened with. Adobe Reader 6 0 release or higher required This may be downloaded from www adobe com. The PDF itself contains the same layout and fields found in the paper remittance advice that described in section 3. below Additionally the remittance can be downloaded and stored electronically for ease of retrieval and you can still. print a hard copy, PDF remittances are not held with the Medicaid check for two weeks but released two weeks earlier. To request the PDF Remittance Advice providers must complete the PDF Paper Remittance Request Form which is. available at www emedny org by clicking on the link PDF Paper Remittance Request Form. 2 3 Paper Remittance Advice, Note Paper remittance advices are being phased out. Remittance advices are also available on paper, Providers who bill electronically but do not specifically request to receive the 835 transaction are sent paper remittance. 2 3 1Remittance Sorts, The default sort for the paper remittance advice is. Claim Status denied paid pending Patient ID TCN, Providers can request other sort patterns that may better suit their accounting systems The additional sorts available.
are as follows,TCN Claim Status Patient ID Date of Service. Patient ID Claim Status TCN,Date of Service Claim Status Patient ID. To request a sort pattern other than the default providers must complete the Paper Remittance Sort Request Form. which is available at www emedny org by clicking on the link to the web page as follows Paper Remittance Sort Request. For additional information providers may also call the eMedNY Call Center at 800 343 9000. REMITTANCE ADVICE,Version 2013 01 7 31 2013,Page 6 of 108. PAPER REMITTANCE ADVICE SECTIONS,3 Paper PDF Remittance Advice Sections. This section presents samples of provider remittance advices followed by an explanation of the. elements contained in the section Unless otherwise noted the remittance sections are the same for all. provider types, The information displayed in the remittance advice samples is for illustration purposes only The.
following information applies to a remittance advice with the default sort pattern. The remittance advice is composed of five sections. Section One may contain one of the following documents. Medicaid Check,Notice of Electronic Funds Transfer. Summout no claims paid, Section Two Provider Notification special messages. Section Three Claim Detail, The layouts and field descriptions for each of the following remittance types will be described in. this section,Child Care,Clinic APG,Durable Medical Equipment DME. Home Health,Nursing Home,Practitioner,Transportation.
Section Four may contain any of the following documents. Financial Transactions recoupments, Accounts Receivable cumulative financial information. Section Five Edit Error Description,REMITTANCE ADVICE. Version 2013 01 7 31 2013,Page 7 of 108,PAPER REMITTANCE ADVICE SECTIONS. 3 1 Section One Medicaid Check, This section contains the check stub and the Medicaid check payment A Medicaid check is issued. when the provider has claims approved for the cycle and the paid amount is greater than any. recoupment amounts scheduled for the cycle,Exhibit 3 1 1.
TO CITY PHARMACY DATE 2007 08 06,REMITTANCE NO,2007 08 06. CITY PHARMACY,111 PARK AVENUE,ANYTOWN NY 11111, YOUR CHECK IS BELOW TO DETACH TEAR ALONG PERFORATED DASHED LINE. DATE REMITTANCE NUMBER PROVIDER ID NO DOLLARS CENTS. 2007 08 06 104 88,VOID AFTER 90 DAYS,THE CITY PHARMACY. 111 PARK AVENUE,ANYTOWN NY 11111,MEDICAL ASSISTANCE TITLE XIX PROGRAM. CHECKS DRAWN ON FIRSTNAME LASTNAME,KEY BANK N A,AUTHORIZED SIGNATURE.
60 STATE STREET ALBANY NEW YORK 12207,REMITTANCE ADVICE. Version 2013 01 7 31 2013,Page 8 of 108,PAPER REMITTANCE ADVICE SECTIONS. 3 1 1Medicaid Check Stub Field Descriptions,Upper Left Corner. Provider s Name as recorded in the Medicaid files,Upper Right Corner. Date the remittance advice was issued,Remittance Number.
PROV ID This field will contain the Medicaid Provider ID and the NPI when applicable. Note For reissued checks the original check number will be displayed beneath the PROV ID. Medicaid Provider ID NPI Date,Provider s Name Address. 3 1 2Medicaid Check Field Descriptions,Date the check was issued. Remittance Number, Provider ID No This field will contain the Medicaid Provider ID and the NPI when applicable. Provider s Name Address,Right Side,Dollar Check Amount This amount is the. the Net Total Paid Amount under the Grand Total subsection. the total sum of the Financial Transaction section. REMITTANCE ADVICE,Version 2013 01 7 31 2013,Page 9 of 108.
REMITTANCE ADVICE FORMATS,3 2 Section One EFT Notification. This section indicates the amount of the EFT An EFT transaction is processed when the provider has claims approved. for the cycle and the paid amount is greater than any recoupment amounts scheduled for the cycle. Exhibit 3 2 1,TO CITY PHARMACY DATE 2007 08 06,REMITTANCE NO. 2007 08 06,CITY PHARMACY,111 PARK AVENUE,ANYTOWN NY 11111. CITY PHARMACY 104 88, PAYMENT IN THE ABOVE AMOUNT WILL BE DEPOSITED VIA AN ELECTRONIC FUNDS TRANSFER. REMITTANCE ADVICE,Version 2013 01 7 31 2013,Page 10 of 108.
REMITTANCE ADVICE FORMATS,3 2 1EFT Notification Page Field Descriptions. Upper Left Corner,Provider s Name as recorded in the Medicaid files. Upper Right Corner, Date The date on which the remittance advice was issued. Remittance Number, PROV ID This field contains the Medicaid Provider ID and the NPI when applicable. Medicaid Provider ID NPI Date,Provider s Name Address.
Provider s Name Amount transferred to the provider s account. This amount is the, Net Total Paid Amount from the Grand Total subsection. the total sum of the Financial Transaction section. REMITTANCE ADVICE,Version 2013 01 7 31 2013,Page 11 of 108. REMITTANCE ADVICE FORMATS,3 3 Section One Summout No Payment. A summout is produced when the provider has no positive total payment This may happen when the provider has. claims approved for the cycle and the expected paid amount is less than or equal to any recoupment amounts scheduled. for the cycle,Exhibit 3 3 1,TO ABC PHARMACY,DATE 08 06 2007. REMITTANCE NO, NO PAYMENT WILL BE RECEIVED THIS CYCLE SEE REMITTANCE FOR DETAILS.
CITY PHARMACY,111 PARK AVENUE,ANYTOWN NY 11111,3 3 1Summout No Payment Field Descriptions. Upper Left Corner,Provider s Name as recorded in the Medicaid files. Upper Right Corner,Date the remittance advice was issued. Remittance Number, PROV ID This field contains the Medicaid Provider ID and the NPI when applicable. Notification that no payment was made for the cycle no claims were approved. Provider s Name Address,REMITTANCE ADVICE,Version 2013 01 7 31 2013.
Page 12 of 108,REMITTANCE ADVICE FORMATS,3 4 Section Two Provider Notification. This section is used to communicate important messages to providers. Exhibit 3 4 1,DATE 08 06 07,CYCLE 1563,TO ABC CHILD CARE CHILD CARE. 123 MAIN STREET PROV ID,ANYTOWN NEW YORK 11111 REMITTANCE NO. REMITTANCE ADVICE MESSAGE TEXT, ELECTRONIC FUNDS TRANSFER EFT FOR PROVIDER PAYMENTS IS NOW AVAILABLE. PROVIDERS WHO ENROLL IN EFT WILL HAVE THEIR MEDICAID PAYMENTS DIRECTLY DEPOSITED. INTO THEIR CHECKING OR SAVINGS ACCOUNT, THE EFT TRANSACTIONS WILL BE INITIATED ON WEDNESDAYS AND DUE TO NORMAL BANKING.
PROCEDURES THE TRANSFERRED FUNDS MAY NOT BECOME AVAILABLE IN THE PROVIDER S. CHOSEN ACCOUNT FOR UP TO 48 HOURS AFTER TRANSFER PLEASE CONTACT YOUR BANKING. INSTITUTION REGARDING THE AVAILABILITY OF FUNDS, PLEASE NOTE THAT EFT DOES NOT WAIVE THE TWO WEEK LAG FOR MEDICAID DISBURSEMENTS. TO ENROLL IN EFT PROVIDERS MUST COMPLETE AN EFT ENROLLMENT FORM THAT CAN BE. FOUND AT WWW EMEDNY ORG CLICK ON PROVIDER ENROLLMENT FORMS WHICH CAN BE FOUND. IN THE FEATURED LINKS SECTION DETAILED INSTRUCTIONS WILL ALSO BE FOUND THERE. AFTER SENDING THE EFT ENROLLMENT FORM TO EMEDNY PLEASE ALLOW A MINIMUM TIME OF SIX. TO EIGHT WEEKS FOR PROCESSING DURING THIS PERIOD OF TIME YOU SHOULD REVIEW. YOUR BANK STATEMENTS AND LOOK FOR AN EFT TRANSACTION IN THE AMOUNT OF 0 01 WHICH EMEDNY. WILL SUBMIT AS A TEST YOUR FIRST REAL EFT TRANSACTION WILL TAKE PLACE APPROXIMATELY. FOUR TO FIVE WEEKS LATER, IF YOU HAVE ANY QUESTIONS ABOUT THE EFT PROCESS PLEASE CALL THE EMEDNY CALL CENTER. Providers with multiple ETINs who receive the 835 820 electronic remittance advice may elect to receive the status of paper claim submissions state submitted

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