Payments Reference Report shows summary of payment references received from payers. This is an Excel file containing three worksheets - levels of data aggregation:
- Payment References
- Claim Payments
- Activity Payments
...
Column | RA Field | Description |
|---|---|---|
| Sender ID | Header.SenderID | License number of an insurance company or TPA that is the sender of Remittance.Advice transaction. |
| Sender Name | Organisation name of an insurance company or TPA that is the sender of Remittance.Advice transaction. | |
| Receiver ID | Header.ReceiverID | License number of an insurance company of a facility that is the receiver of Remittance.Advice transaction. |
| Receiver Name | Organisation name of an insurance company of a facility that is the receiver of Remittance.Advice transaction. | |
| Settlement Date | Claim.DateSettlement | Date the payer settles a claim. |
| Payment Reference | Claim.PaymentReference | Unique identifier for the payment transaction (cheque number, bank transfer number, payment voucher number). |
| Payment Amount | Payment amount for a claims batch. Calculates as the sum of Activity.PaymentAmount for the respective activities. |
Data in the worksheet is sorted by:
- Settlement Date, descending;
- Payer ID, ascending;
- Payment Reference, ascending.
...
Column | RA Field | Description |
|---|---|---|
| Sender ID | Header.SenderID | License number of an insurance company or TPA that is the sender of Remittance.Advice transaction. |
| Sender Name | Organisation name of an insurance company or TPA that is the sender of Remittance.Advice transaction. | |
| Receiver ID | Header.ReceiverID | License number of a facility that is the receiver of Remittance.Advice transaction. |
| Receiver Name | Organisation name of a facility that is the receiver of Remittance.Advice transaction. | |
| Payer ID | Claim.PayerID | License number of an insurance company that is the payer of a claim. |
| Payer Name | Organisation name of an insurance company that is the payer of a claim. | |
| 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. |
| Encounter Start | Encounter.Start | Encounter start date and time. If a claim has more than one encounter, then this value is taken from the earliest encounter. |
| Member ID | Claim.MemberID | Insurance card number of the patient. |
| MRN | Encounter.PatientID | Patient Medical Record Number assigned by the provider. |
| Settlement Date | Claim.DateSettlement | Date the payer settles a claim. |
| Payment Reference | Claim.PaymentReference | Unique identifier for the payment transaction (cheque number, bank transfer number, payment voucher number). |
| Payment Amount | Payment amount for a claim. Calculates as the sum of Activity.PaymentAmount for the respective activities. |
Data in the worksheet is sorted by:
- Settlement Date, descending;
- Payer ID, ascending;
- Payment Reference, ascending;
- Claim.ID, ascending.
...
Column | RA Field | Description |
|---|---|---|
| Sender ID | Header.SenderID | License number of an insurance company or TPA that is the sender of Remittance.Advice transaction. |
| Sender Name | Organisation name of an insurance company or TPA that is the sender of Remittance.Advice transaction. | |
| Receiver ID | Header.ReceiverID | License number of a facility that is the receiver of Remittance.Advice transaction. |
| Receiver Name | Organisation name of a facility that is the receiver of Remittance.Advice transaction. | |
| Payer ID | Claim.PayerID | License number of an insurance company that is the payer of a claim. |
| Payer Name | Organisation name of an insurance company that is the payer of a claim. | |
| 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. |
| Member ID | Claim.MemberID | Insurance card number of the patient. |
| MRN | Encounter.PatientID | Patient Medical Record Number assigned by the provider. |
| Activity ID | Activity.ID | Unique identifier of an activity. |
| Auth. Number | Activity.PriorAuthorizationID | Prior authorization number. |
| Rx Number | Observation.Value | Rx Number. It is taken from an observation with Observation.Code = Prescription No. Column is shown if there is at least one activity with the said observation. |
| Fill Counter | Observation.Value | Fill Counter. It is taken from an observation with Observation.Code = Refills or Fill Counter. Column is shown if there is at least one activity with the said observation. |
| Service Date | Activity.Start | Date of the provided service. |
| Settlement Date | Claim.DateSettlement | Date the payer settles a claim. |
| Payment Reference | Claim.PaymentReference | Unique identifier for the payment transaction (cheque number, bank transfer number, payment voucher number). |
| Payment Amount | Activity.PaymentAmount | Payment amount for an activity. |
| Denial Code | Activity.DenialCode | Denial code for a rejected activity. |
| Denial Reason | Denial code description. |
Data in the worksheet is sorted by:
- Settlement Date, descending;
- Payer ID, ascending;
- Payment Reference, ascending;
- Claim.ID, ascending;
- Activity ID, ascending.