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09/26/2011

Helpful Hints: Reconciling a Detail Redesigned Provider Statistical and Reimbursement System (PS&R) and Remittance Advice

  1. Verify that you have summary and detail PS&R that have matching paid dates
  2. To verify that the amounts on the summary are correct, take the last page of the detail report for each report type and compare the information in the period total section to the summary report:
    1. If the amounts do not match, look for the individual month totals and add them to ensure the period totals are correct
    2. You may also add the month totals to verify that the period totals are correct. The month totals are a sum of the covered visits on each claim of the detail.
  3. Detail PS&Rs are sorted according to the following criteria:
    1. Report Type (Part B Entitlement, Part A, Part B)
    2. Service Through Date
    3. Beneficiary Last Name
    4. Paid Date
    5. DCN
  4. If a claim has been adjusted or canceled, you should see the adjustment or cancel bill on the PS&R with negatives beside the counts and amounts. You should see an original claim on the PS&R for every claim that has negative numbers and amounts.
  5. If you have a claim that is on a remit but not on the PS&R, make sure that you have a PS&R with paid dates that cover the paid date on the remittance advice

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