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 worksheet
The worksheet contains summary of all payment references submitted by payers in Remittance.Advice transactions. 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 |
|---|---|---|
| Sender ID | Header.SenderID | License number of an insurance company or TPA that is the sender of Remittance.Advice transaction. |
| Sender Name | 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 that is the receiver of Remittance.Advice transaction. |
| Receiver Name | Name of an insurance company that is the receiver of Remittance.Advice transaction. | |
| Settlement Date | Claim.DateSettlement | Settlement date of the payment. |
| Payment Reference | Claim.PaymentReference | Payment reference 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.
Claim 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 | 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 | 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 | 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 | Settlement date of the payment. |
| Payment Reference | Claim.PaymentReference | Payment reference 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.
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 | 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 | 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 | 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 | Settlement date of the payment. |
| Payment Reference | Claim.PaymentReference | Payment reference number. |
| Payment Amount | Activity.PaymentAmount | Payment amount for an activity. |
Data in the worksheet is sorted by:
- Settlement Date, descending;
- Payer ID, ascending;
- Payment Reference, ascending;
- Claim.ID, ascending;
- Activity ID, ascending.