6 Remittance and Status (R&S) Reports

6.1 R&S Report Information 6-2

6.1.1 Electronic Remittance and Status (ER&S) Reports 6-2

6.1.2 Banner Pages 6-2

6.1.3 Explanation of R&S Report Row Headings 6-3

6.1.4 Explanation of R&S Report Section Headings 6-4

6.1.4.1 Claims—Paid or Denied 6-4

6.1.4.2 Adjustments to Claims 6-5

6.1.4.3 Financial Transactions 6-5

6.1.4.4 Financial Transactions/Void and Stop—“Stale-Dated Checks” 6-8

6.1.5 Claims Payment Summary 6-8

6.1.5.1 Claims In Process 6-9

6.1.5.2 EOB and EOPS Codes Section 6-9

6.1.6 R&S Report Examples 6-9

6.1.6.1 Physician R&S Report Example: Banner Page 6-10

6.1.6.2 Physician R&S Report Example: Blank Page 6-11

6.1.6.3 Physician R&S Report Example: Claims – Paid or Denied 6-12

6.1.6.4 Physician R&S Report Example: Blank Page 6-13

6.1.6.5 Physician R&S Report Example: Payment Summary Page 6-14

6.1.6.6 Physician R&S Report Example: Explanation of Benefits (EOB) Page 6-15

6.1.6.7 Ambulatory Surgical Center (ASC) R&S Report Example: Banner Page 6-16

6.1.6.8 ASC R&S Report Example: Adjustments R&S Report 6-17

6.1.6.9 ASC R&S Report Example: Blank Page 6-18

6.1.6.10 ASC R&S Report Example: Adjustments R&S Report 6-19

6.1.6.11 ASC R&S Report Example: Adjustments R&S Report 6-20

6.1.6.12 ASC R&S Report Example: Adjustments R&S Report 6-21

6.1.6.13 ASC R&S Report Example: Blank Page 6-22

6.1.6.14 ASC R&S Report Example: Claims in Process R&S Report 6-23

6.1.6.15 ASC R&S Report Example: Claims in Process R&S Report 6-24

6.1.6.16 ASC R&S Report Example: Payment Summary Page 6-25

6.1.6.17 ASC R&S Report Example: Explanation of Benefits (EOB) Page 6-26

6.2 TMHP-CSHCN Services Program Contact Center 6-27