View Remittance Advice Details

The Remittance Advice (RA) Detail page displays specific RA details for the selected account and helps you research RA variances at the account level. The summary at the top of the page includes the patient's name, dates of service, product name, billed charges, total payments and adjustments, expected and actual discounts and other information.

Note: This page is only available if your facility uses the Remittance Advice (RA) feature and there is RA data available for the selected account.

  1. Access the Remittance Advice Detail page.

    If you know the account number:

    • Select Go To > Account Research > By Account Number. The Account Research by Account Number page opens.
    • Type the account number and click Display Account. The Patient Account Audit page opens.
    • Click a REIM link in the View column. The Expected Reimbursement Detail page opens.

      Note: The REIM link is disabled for any account that is included in a PEM claim.

    • Click the View All link under the Reimb. column, next to TOTAL RAs. The Remittance Advice Detail page opens.

    If you do not know the account number:

    • Select Go To > Account Research > from Worklist. The Account Research from Worklist page opens.
    • From the Task list, select Create Worklist.
    • Specify other selection criteria and click Display Accounts. The Account Worklist page opens. For more information about search criteria, refer to Specify Account Worklist Criteria.

      Note: PEM claims are not included in worklist results.

    • Click the account number you want to review in the Account Number column. The Patient Account Audit page opens.
    • Click a REIM link in the View column. The Expected Reimbursement Detail page opens.

      Note: The REIM link is disabled for any account that is included in a PEM claim.

    • Click the View All link under the Reimb. column, next to TOTAL RAs. The Remittance Advice Detail page opens.
  2. View the remittance advice details.
  3. Click the Account Number link in the Patient Summary to view the Patient Account Audit page. For more information, refer to View the Patient Account Audit Page .
  4. For outpatient accounts, click an RA link in the Reimb. column to show or hide the line item details for each RA.
    • Only outpatient accounts on the Remittance Advice Detail page include links to expandable line items with more details about the RA.
    • Inpatient accounts include all information in the tables as shown, based on the type of account (for example, acute, rehab, or SNF).
  5. For outpatient accounts, click the Totals link in the Reimb. column to show or hide the Line Item Summary of all the RA’s listed above.

The following table provides field definitions for the summary sections on the Remittance Advice Detail page (applicable only if FinThrive reprices claims that contain RA for your facility).

Field

Description

Account Number

Patient account number (for UB claims) or insured ID (for CMS-1500 claims)

Actual Discount

Total insurance adjustments for all accounts; Explanation of Benefits (EOB) write-off

Admit Date

Date of admission for the account

Bill Type

Bill type

Billed Charges

The total charges incurred for the claim or set of claims that have been repriced

Dates of Service

The range of date of service from and date of service to for the claim

Discount Variance

Expected Discount minus the Actual Discount

Expected Discount

Billed Charges minus non-covered charges, minus Total Expected Reimbursement

Expected Insurance Payment

The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data, minus patient liability

Insurance Payment

The amount paid by the insurance company

Late Payment Penalty

The dollar amount of the late payment penalties calculated for the account. The rules defining late payment penalties are defined in the contract profile.

Non-Contractual/Other Adjustments

Other, non-insurance adjustments

Non-Covered Charges

The amount of non-covered charges (not disallowed charges)

Other Contractual Write-Offs

Other insurance adjustments not included in the discount variance

Patient Liability

The amount the patient is responsible for

Patient Name

Patient name

Patient Payment

Portion paid by the patient

Patient Type

Patient type assigned to the account: Inpatient/Outpatient

Primary Diagnosis

Primary diagnosis code. This field provides a link to additional information about the code.

Click the link to view basic information about the code.

KnowledgeSource subscribers can log in to KnowledgeSource to view detailed information about the code.

Product

Name of the insurance product

For detailed descriptions of the remittance advice details for specific account types, refer to the following: