Content Comparison

This report shows mapping between claims and remittance advices. Report contains all claims submitted by providers. Some claims will have Remittance Advices, the other claims will not have them. However, all claims present in this report.

Claim Reconciliation Report

This worksheet contains history of all claims submitted by provider in Claim.Submission transactions.
Data in the worksheet are sorted by:
1. Sender ID
2. Claim ID
3. Submission Date.
Table below describes columns presented on this worksheet.

Column	CS Field	Description
First CS Date	Header.TransactionDate	Transaction date and time of the first Claim.Submission transaction.
Last CS Date	Header.TransactionDate	Transaction date and time of the latest Claim.Submission transaction where a claim is either correction or internal complaint. If a claim has no resubmission, then it equals First CS Date.
First RA Date	Header.TransactionDate	Transaction date and time of the first Remittance.Advice transaction.
Last RA Date	Header.TransactionDate	Transaction date and time of the latest Remittance.Advice transaction.
Claim ID	Claim.ID	Unique identifier assigned to a claim by the provider.
Claim ID Payer	Claim.IDPayer	Unique identifier assigned to a claim by the payer.
Pt Visit Date	Encounter.Start
Pt Visit Date Time	Encounter.Start
Sender ID	Header.SenderID	License number of a facility that is the sender of Claim.Submission transaction.
Reciever ID	Header.ReceiverID	License number of an insurance company or TPA that is the receiver of Claim.Submission transaction.
Payer ID	Claim.PayerID	License number of an insurance company that is the payer of a claim.
Provider ID	Claim.ProviderID	License number of the provider.
Member ID	Claim.MemberID	Insurance card number of the patient.
MRN	Encounter.PatientID	Patient Medical Record Number assigned by the provider.
Original Claimed Amount	Activity.Net
Current Claimed Amount	Activity.Net
Patient Share	Activity.PatientShare
Pending Amount
Original Paid Amount	Activity.PaymentAmount
Paid Amount	Activity.PaymentAmount	Amount paid by the payer for a claim.
Denied Amount
Write Off Amount
Final Denied Amount
Denied Clearing Error
Processed Amount
Principal Diagnosis	Diagnosis.Code	Principal diagnosis code.
Diagnosis Text		Principal diagnosis description.
Secondary Diagnosis 1...N	Diagnosis.Code	Secondary diagnosis code. This value is taken from diagnosis that has Diagnosis.Type <> Principal.
Diagnosis Text		Secondary diagnosis description.
Payment Status		Paid — a claim is fully paid (Paid Amount >= Processed Amount); Partly Paid — a claim is partly paid (Paid Amount < Processed Amount); Denied — a claim is fully denied (Paid Amount = 0); In Process — remittance advice is not received for the claim: a new claim is submitted and no remittance advice is yet received; a claim resubmission (correction or internal complaint) is submitted and no remittance advice is yet received; in this case Paid Amount may have value from previous claim submissions; Written Off — a claim is written off using /wiki/spaces/RES/pages/75961340.
Claim Status		Original — if this is the initial claim submission; Resubmission 1 — if this is the first claim resubmission; Resubmission N — if this is N claim resubmission.
Missed Take Back

Activity Reconciliation Report

Table below describes columns in the report.

Column	Transaction Field	Description
First CS Date	Header.TransactionDate	Date Transaction date and time of the first Claim.Submission transaction.
Last CS Date	Header.TransactionDate	Date Transaction date and time of the last latest Claim.Resubmission, either Correction or Internal ComplaintSubmission transaction where a claim is either correction or internal complaint. If a claim has no resubmission, then it equals First CS Date.
First RA Date	Header.TransactionDate	Date Transaction date and time of the first Remittance.Advice transaction.
Last RA Date	Header.TransactionDate	Date Transaction date and time of the last latest Remittance.Advice transaction.
Rx Number	Observation.Value	Rx Number; value is taken for observation with Observation.Code = "Prescription No".
Fill Counter	Observation.Value	Fill Counter; value is taken for observation with Observation.Code = "Refills" or "Fill Counter".
Code	Activity.Code	Activity code specified by activity type.
Type		Activity type.
Description		Activity code description.
Claim ID	Claim.ID	Unique identifier assigned to a claim by the provider.
Claim ID Payer	Claim.IDPayer	Unique identifier assigned to a claim by the payer.
Activity ID	Activity.ID	Unique identifier of an activity within a claim.
Auth. Number	Activity.PriorAuthorizationID	Prior authorization number.
Auth. Approval Date		Authorization approval date. Always N/A until future versions.
Service Date	Activity.Start	Date of the provided service.
Service Date Time	Activity.Start	Date and time of the provided service.
Ord. Clinician License	Activity.OrderingClinician	License number of the clinician who ordered an activity or referred the patient for an activity.
Ord. Clinician Name		Full name of the clinician who ordered an activity or referred the patient for an activity..
Disp. Clinician License	Activity.Clinician	License number of the clinician who provided an activity (treatment or care) for the patient.
Disp. Clinician Name		Full name of the clinician who provided an activity (treatment or care) for the patient..
Sender ID	Header.SenderID	License number of a facility that is the sender of Claim.Submission transaction.
Receiver ID	Header.ReceiverID	License number of an insurance company or TPA that is the receiver of Claim.Submission transaction.
Payer ID	Claim.PayerID	License number of an insurance company that is the payer of a claim.
Provider ID	Claim.ProviderID	License number of the provider.
Member ID	Claim.MemberID	Insurance card number of the patient.
MRN	Encounter.PatientID	Patient Medical Record Number assigned by the provider.
Sales Price		Sales price for the drug. It has value only if Activity.Type = 5.
Quantity	Activity.Quantity	Dispensed quantity (number of units) for an activity.
Original Claimed Amount	Activity.Net value in Net	Net amount for an activity from the first Claim.Submission transaction.
Current Claimed Amount	Activity.NetClaimed	amountNet amount for an activity from the latest Claim.Submission transaction.
Patient Share	Always N/A until future versionsActivity.PatientShare	Any fee that the payer is expecting the provider to collect from the patient.
Pending Amount		Pending Amount is shown as described in the logic above.
Original Paid Amount	Activity.PaymentAmount	Paid Amount is sum of all Remittance Advices for this claim.
Paid AmountThis column is the same as Original Paid Amount considered all workarounds described above	Activity.PaymentAmount	Amount paid by the payer for an activity.
Missed Take Back		Logic to calculate this value is described in section 74716133. Default value for this column is No
Denied Amount		Denied Amount is calculated using the following logic: Claimed Amount from the latest Remitted Claim denied by the payer for an activity. Calculated as Current Claimed Amount – Total Paid Amount for this claim.
Write Off Amount		Write Off Amount as per latest /wiki/spaces/RES/pages/75961340.
Write Off Date		Date when the amount is written off as per latest /wiki/spaces/RES/pages/75961340.
Final Denied Amount		Calculates as Denied Amount – Write Off Amount.
Denied Clearing Error		Logic to calculate this value is described in seciton Clearing Errors in Remittance.Advice.
Processed Amount		Calculates as Paid Amount + Denied Amount.
Denial Code	Activity.DenialCode	Denial code for a rejected activity.
Denial Reason		Denial code description.
Principal Diagnosis	Diagnosis.Code	Principal diagnosis code.
Diagnosis Text		Principal diagnosis description.
Secondary Diagnosis 1...N	Diagnosis.Code	Secondary diagnosis code. This value is taken from diagnosis that has Diagnosis.Type <> Principal.
Diagnosis Text		Secondary diagnosis description.
Payment Status		Claim status that may have one of the following values: `Paid` — claim Paid — a claim is fully paid (payment is the same as claimed amount or greater).Paid Amount >= Processed Amount); Partly Paid — claim a claim is partly paid (payment is less than claimed).`Denied` — claim Paid Amount < Processed Amount); Denied — a claim is fully denied (payment is zero).Paid Amount = 0); In Process — remittance advice is not received for the claim. Claims will have this status in the following scenario: New a new claim is submitted and no remittance advice is yet received . ; Claim a claim resubmission (correction or internal complaint) is submitted and no remittance advice is yet received . In ; in this case Paid Amount may have value from previous claim submissions . ; Written Off — a claim is written off using /wiki/spaces/RES/pages/75961340.
Claim StatusThis column may have the following values:		Original — if this is the initial claim submission.; Resubmission 1 — if this is the first claim resubmission.; Resubmission N — if this is N claim resubmission.

Version	Old Version 1	New Version 2
Changes made by	vickyp	vickyp
Saved on	May 02, 2019	May 04, 2019

Versions Compared

Key

Claim Reconciliation Report

Activity Reconciliation Report