Guidance Regarding Elimination of Standard Paper Remittance (SPR) Advice Notices in the Old Format for RHHI, second revision

Related Change Request (CR) #: N/A
Medlearn Matters Number: SE0451

Effective Date: N/A
Implementation Date: January 1, 2005 for providers billing carriers, April 4, 2005 for providers billing fiscal intermediaries

Note: This article was revised on November 19, 2004, to correct a typographical error in the second sentence of the Background section. Specifically, the phrase 'date elements' was corrected to read 'data elements.'

Note: This article was revised on December 7, 2004 to revise the implementation date for providers billing fiscal intermediaries (FIs) and clarifies expectations for carrier changes.

Provider Types Affected
All Medicare physicians, providers, and suppliers.

Provider Action Needed
The Centers for Medicare & Medicaid Assistance (CMS) has issued a memorandum to all Medicare carriers and FIs, including Durable Medical Equipment Regional Carriers (DMERCs) and Regional Home Health Intermediaries (RHHIs) stating that, effective January 1, 2005, only the 835 version 4010A1 flat file
is to be used to produce the Standard Paper Remittance (SPR) advice notices; no other format for SPRs will be used.

Background
CMS prohibits the inclusion of data in paper remittance advice notices that is not included in the Electronic Remittance Advice (ERA) transactions. The most recent version of the SPR advice and the ERA contain the same information in the comparable fields and data elements, including the same codes. The same flat file should be used to produce both the SPR and 835 version 4010A1 ERA.

Note: The effective date has been revised to April 4, 2005 for FIs.

Providers billing intermediaries are also advised that they may see new data elements in their SPRs, i.e.:

• An additional field for the new technology add-on payment;
• A 'PRE PAY ADJ' (presumptive payment adjustment) field in the claim detail section; and
• A new field to report a provider-level adjustment used to balance an 'out of balance' remittance on the SPR summary page.

Providers billing carriers should note that not all carriers and DMERCs will be able to create SPRs directly from an 835 flat file. In such cases, carriers and DMERCs may continue to follow current practices for SPR preparation, but they must ensure that each SPR issued contains the same data elements that would be reported in the equivalent segments and data elements of an 835 version 4010A1 if produced for the same claims and provider. This applies to SPRs produced both for providers that have already transitioned to the 835 version 4010A1, and to those that received earlier versions of the 835 or the National Standard Format ERA pending transition.

Also, providers billing carriers and DMERCs should know that carriers and DMERCs have been told that SPRs may not contain data, other than the contractor's name and address and some calculated totals (as permitted in the SPR format in Chapter 22 of the Medicare Claims Processing Manual), that is not reported in the ERA.

Additional Information
Refer to Chapter 22 of the Medicare Claims Processing Manual, Publication 100-4, which can be found online at:
http://www.cms.hhs.gov/manuals/104_claims/clm104c22.pdf

Additional information regarding the Fiscal Intermediary Part A 835 flat file, including a sample of the most recent SPR format, is available in CR 3344. You may view that CR at:
http://www.cms.hhs.gov/manuals/pm_trans/R252CP.pdf

If you have any questions regarding receipt of or conversion to ERAs, please contact your carrier/intermediary. If you bill an intermediary, their number may be found at:
http://www.cms.hhs.gov/providers/edi/anum.asp

If you bill a carrier, the number may be found at:
http://www.cms.hhs.gov/providers/edi/bnum.asp

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