Health Care Payment/Advice (Remittance Advice)
The 835 Electronic Remittance Advice (ERA) is the industry standard electronic version of a remittance advice and is intended to update the provider's accounts receivables systems automatically. It contains an explanation of claims payments, claims denials, and other financial information necessary for providers to reconcile patient accounts. In many instances, the 835 replaces the paper remittance advice altogether, alleviates manual handling associated with paper documentation, enhances workflow and reduces administrative burdens overall for our customers.
Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) are reported on the 835 ERA instead of payer's proprietary adjustment reason and denial codes. These standard reason and remark codes advise providers 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 Florida Blue or any payer. Some CARC definitions can be more generic than Florida Blue proprietary codes while RARC definitions provide more specific information related to adjudication of the claim. Both CARC and RARC codes are used industry wide and tend to avoid payer specific language when possible although RARCs do tend to be more lenient than CARCs when it comes to specificity. There are certain generic CARCs reported on the 835 ERA that require at least one accompanying RARC to be returned as well which will provide clear information regarding 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.
The Remittance Viewer enables users to view, search, reconcile and print an Electronic Remittance Advice (ERA). Florida Blue proprietary information is included with the ERA on Remittance Viewer. Availity will store up to seven years of the remit information within the Remittance Viewer. 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 use the Remittance Viewer tool, an Availity registration is required. Registration, and training, are free of charge and can be obtained by visiting www.availity.com