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
Payment References
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worksheet
The worksheet contains
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summary of all payment references submitted by payers in Remittance.Advice transactions.
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Data in the worksheet is sorted by:
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Claims are grouped by the same Settlement Dtae and Payment Reference number.
The table below describes the columns presented on this worksheet.
Column | RA Field | Description |
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| Sender ID | Header.SenderID | License number of an insurance company or TPA that is the |
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| sender of Remittance.Advice transaction. | ||
| Sender Name | Organisation name of an insurance company or TPA that is the |
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| 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. | |
| Settlement Date |
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| Claim.DateSettlement | Date the payer settles a claim. | |
| Payment Reference |
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| Claim.PaymentReference | Unique identifier for the payment transaction (cheque number, bank transfer number, payment voucher number). | |
| Payment Amount |
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Payment amount for a claims batch. Calculates as the sum of |
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Activity.PaymentAmount |
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for the |
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Claim Payments Worksheet
Thie worksheet contains payment references for every claim submitted by payers in Remittance.Advice transactions.
respective activities. |
Data in the worksheet is sorted by:
- Settlement Date, descending;
- Payer ID, ascending;
- Payment Reference, ascending
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Claim
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Payments worksheet
The worksheet contains payment references for every claim submitted by payers in Remittance.Advice transactions.
The table below describes the columns presented on this worksheet.
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 |
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| Organisation name of an insurance company that is the payer of a claim. | ||
| Claim ID | Claim.ID | Unique identifier assigned to a claim by |
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| the provider. |
| Claim ID Payer |
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| Claim.IDPayer | Unique identifier assigned to a claim by |
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| 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 |
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the patient. | ||
| MRN | Encounter.PatientID | Patient Medical Record Number assigned by the provider. |
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| RA Date |
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| Header.TransactionDate | The date when insurance sent RA on Shafafiya. | |
| Claimed Amount | Claim.Net | Claimed amount of the claim. This value is taken from the respective Claim.Submission transaction. |
| Settlement Date | Claim.DateSettlement | Date the payer settles a claim. |
| Payment Reference |
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| Claim.PaymentReference | Unique identifier for the payment transaction (cheque number, bank transfer number, payment voucher number). | |
| Payment Amount | Payment amount for |
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a claim. Calculates as the sum of Activity.PaymentAmount for the respective activities |
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Activity Payments Worksheet
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. |
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Data in the worksheet is sorted by:
- Settlement Date, descending;
- Payer ID, ascending;
- Payment Reference, ascending;
- Claim.ID, ascending
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- .
Activity Payments worksheet
The worksheet contains payment references for every activity submitted by payers in Remittance.Advice transactions.
The table below describes columns presented on this worksheet.
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 |
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| Organisation name of an insurance company that is the payer of a claim. | |
| Claim ID | Claim.ID |
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| Unique identifier assigned to a claim by the provider. | |
| Claim ID Payer |
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| 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 |
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| Claim.DateSettlement | Date the payer settles a claim. | |
| RA Date | Header.TransactionDate | The date when insurance sent RA on Shafafiya. |
| Claimed Amount | Activity.Net | Claimed amount of the claim. |
| Payment Reference |
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| 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. | |
| Ordering Clinician | Activity.OrderingClinician | Ordering clinician license. Note: This value is taken from the respective Claim.Submission transaction. |
| Ordering Clinician Name | Name of the ordering clinician. | |
| Clinician | Activity.Clinician | Clinician license. Note: This value is taken from the respective Claim.Submission transaction. |
| Clinician Name | Name of the clinician. |
Data in the worksheet is sorted by:
- Settlement Date, descending;
- Payer ID, ascending;
- Payment Reference, ascending;
- Claim.ID, ascending;
- Activity ID, ascending.