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Health Care Payment

Health Care Payment/Advice (Remittance Advice)

 

Electronic Remittance

The 835 ERA is the electronic version of the paper remittance advice. It contains an explanation of claims payments, claims denials, and other financial information necessary for providers to reconcile patient accounts.

CARCs and RARCs display on the 835 ERA. They identify standard reasons why payment may be different than the submitted charge. CARCs and RARCs are mandated by HIPAA-AS and the code definitions cannot be changed by BCBSF or any payer. CARC definitions tend to be generic while RARC definitions provide more information related to adjudication of the claim. HIPAA-AS requires that for every five CARCs displayed on the 835 ERA at least one RARC must be returned as well to provide clearer information when claim payments are denied or reduced. To obtain the most recent and complete list of CARCs and RARCs, visit the Washington Publishing Company website.

Providers can receive ERAs delivered to their Availity Receive Files mailbox or other mailbox as desired. Some billing systems can import the information to automate posting of accounts receivables. Providers interested in receiving ERAs should follow the instructions on the 835 Health Care Electronic Remittance Advice (ERA) Request Form.
 

Remit Reader

The Availity Remit Reader enables users to view, search, reconcile and print Electronic Remittance Advice (ERA) or 835 files. Florida Blue proprietary information is included with the HIPPA 835 data. Availity will store up to 7 years of the remit information within the Remit Reader. This solution replaces the paper remittance and is available the same day the financial cycle is completed at Florida Blue. This tool makes it easier to search and locate information and sort by Check/EFT, Patient and Claim data. A PDF document can be generated for printing or saving capabilities. 
 
To utilize the Remit Reader tool, an Availity registration is required. Registration, along with training, are free of charge and can be obtained by visiting www.availity.com. 
 
7/19/2012
The Manual is not intended to be a complete statement of all BCBSF polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and BCBSF or Health Options the terms of such agreement(s) shall govern.
The Manual is not intended to be a complete statement of all Florida Blue polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and Florida Blue or Health Options the terms of such agreement(s) shall govern.

Refer to the References section to view all applicable copyrights, registered trademarks, service marks, and/or references. Acronyms are also defined in the References section.

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