Claim.Remittance Riayati

Template

Use the following template to fill in remittances: (template) Claim.Remittance - Riayati.xlsx

Data description

The table below describes each column in the expected Excel file. Some columns are always required (Mandatory = Yes), some are optional, and some are conditional (depend on data entry).

Worksheet	Column	Mandatory	Description	Possible Values
Claims	Sender ID	Yes	The license number of a healthcare entity that is the sender of the transaction. Should be synchronized with LMU HIC or TPA ID.
	Receiver ID	Yes	The license number of a healthcare entity that is the receiver of the transaction. Should be synchronized with LMU License ID.
	Payer ID	Yes	HIC or Self Paid ID allowed licenses registered in the Riayati LMU. HIC or Self Paid License if Sender ID is TPA. If Sender ID is HIC, Payer ID must be equal to Sender ID. If Payer ID is SP, Sender ID must be TPA.
	Claim ID	Yes	A unique number assigned by a healthcare provider to identify the claim. This is also known as the provider’s claim reference number. If the patient is not insured and pays out of pocket, this is the external invoice reference number.
	ID Payer	Yes	A unique number assigned by an insurer to identify the claim. It helps the provider and payer to locate the claim.
	Provider ID	Yes	The facility license number of the healthcare provider claiming from the payer.
	Denial Code	No	Payer's reason for the claim denial, as represented by a code.
	Payment Reference	Yes	A unique identifier for the payment transaction that depends on the way of payment: the check number for payments by a check; bank transfer number for payment by a bank transfer; payment voucher number for cash payments.
	Date Settlement	No	The date the payer settles the claim. This is the date that payment is made. If the payment is made in several steps, the latest date is used. If the value of the claim agreed by the payer is 0, the settlement does not entail payment.	dd/mm/yyyy hh:mm
	Facility ID	No	The license number of the facility responsible for the encounter.
Activities	Claim ID	Yes	Reference to Claim ID on Claims worksheet
	Activity ID	Yes	Unique identifier of activity within a claim.
	Activity Start	Yes	The date and time at which an activity started. For a DRG code, it is the date and time of discharge. If the date, but not the time is recorded, the time is assumed to be 00:00.	dd/mm/yyyy hh:mm
	Activity Type	Yes	The type of activity/procedure.	3 = CPT 4 = HCPCS 5 = Trade Drug 6 = Dental 8 = Service 9 = DRG
	Activity Code	Yes	An activity code, specified by its type for the activity performed.
	Quantity	Yes	The number of units for an activity.	Float with max 2 digits in the decimal part (for example, 10, 8.25)
	Net	Yes	The net charges billed by the provider to the payer for an activity.	Float with max 3 digits in the decimal part (for example, 11.5, 260.125)
	List	No	The list price before any adjustments of discounts.
	Clinician	Yes	The license number of the clinician responsible for the activity. In general, this is the person providing the treatment or care for the patient. Exceptions: the clinician is the ordering physician for labs, x-rays, prescriptions, other tests; the clinician is the attending consultant physician at the time of discharge of the patient from the hospital if the activity is an inpatient service code.
	Prior Authorization ID	No	The corresponding prior authorization number.
	Gross	Yes	The total amount of the charges included in the activity. It is any patient financial responsibility for the activity, such as co-pays and deductibles, as well as charges made to other insurers for the encounter(s) covered by the activity.	Float with max 3 digits in the decimal part (for example, 20, 280.750)
	Patient Share	Yes	Any fee that payer is expecting the provider to collect from the patient.	Float with max 3 digits in the decimal part (for example, 8.5, 20.625)
	Activity Penalty	No	Any details for the calculation of the late submission.
	Payment Amount	Yes	Approved amount to be paid by the payer towards the activity.	Float with max 3 digits in the decimal part (for example, 32.25, 44.125)
	Denial Code	No	Payer's reason for the activity denial, as represented by a code.
	Comments	No	Optional comments left by the payer.