Electronic Remittance Advice Formatting Concerns

Electronic Remittance Advice Formatting Concerns



The Centers for Medicare & Medicaid Services (CMS) issued a Medicare Learning Network Matters article 7499, titled “Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number”; the implementation date for supplier submitted claims to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) was October 1, 2012.  



CMS determined that providing the Patient Control Number as received on the original claim rather than the Health Insurance Claim (HIC) number would:


•    Enhance provider ability to automate payment posting, and


•    Reduce the need for additional communication (via telephone calls, etc.) and that would subsequently reduce the costs for providers as well as Medicare.  


Since the implementation of this change the DME MACs have received calls from suppliers who indicate their electronic remittance advices (ERAs) are not formatting correctly. On October 8, 2012 the Common Electronic Data Interchange (CEDI) sent a reminder to the supplier community to upgrade to the 3.3 version of Medicare Remit Easy Print (MREP) so their ERAs will format correctly.  



If you are a durable medical equipment prosthetics, orthotics, and supplies (DMEPOS) supplier who is encountering this problem, you should be aware that this is not a DME MAC issue but rather an issue with supplier software. Suppliers should contact their software vendors or clearinghouses to have their software updated as soon as possible so that their remits will format properly.



Note: If you received an ERA that was not properly formatted because your software was not updated, once updated suppliers can simply reprint the ERA. There is no need to contact the DME MACs.



This does not apply to suppliers who continue to receive standard paper remits.




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