Claim.Remittance Riayati
- vickyp
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.
| ||
| 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:
| ||
| 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:
| ||
| 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. |