Reading the Updated Standard Paper Remittance (SPR) Advice
Reference: CR #8349
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Medicare Services has received several inquiries from providers
requesting clarification of the new reason codes for adjustments and
offsets that are included on the Standard Paper Remittance (SPR)
advice. The crosswalk below should provide assistance.
|
Old Adj/offset
Reason Codes |
New Adj/offset
Reason Codes |
Description |
|
BF |
FB |
Forwarding Balance |
|
AP |
AP |
Acceleration of benefits |
|
LP |
SL |
Student
Loan |
|
OF |
WO |
Withholding |
|
IL |
LE |
Levy |
|
WH |
IR |
IRS |
|
IN |
L6 |
Interest |
|
RI |
CS |
Adjustment |
|
AJ |
J1 |
Nonreimbursable |
|
RF |
B2 |
Rebate |
|
LF |
50 |
Late
Filing |
|
J1 |
J1 |
Nonreimbursable |
Because the "MSP" and "Paid to Beneficiary" fields were eliminated,
such claim payment adjustments are being reported at the bottom of the
claim detail with reason code "CS." This will be corrected July 1,
2002, at which time, the "MSP" and "Paid to Beneficiary" information
will be reported in the "Total RC-AMT field." To determine the type of
claim adjustment made, refer to the remarks codes. For example,
OA-71indicates a primary payment and CO-A3 indicates that Medicare is
secondary.
Another issue that has arisen because of the changes to the SPR is
the reconciliation of the remittance advice for MSP claims. Because of
these changes, the amount indicated in the PROV PD field does not
represent the actual amount paid to the provider. To obtain the
correct amount paid on the claim, take the amount in the PROV PD field
and subtract the amount at the end of the register under PROVIDER ADJ
DETAILS with a CS reason code. To rectify this situation, we will be
implementing changes to the SPR July 1, 2002, so that this information
is clearer. Please refer to the
examples that indicate how the revised
SPR will more accurately indicate claim payments. |
