With each check you will receive a Provider Remittance Advice (PRA), which is a statement explaining the services that are being paid. Similarly, patients receive an Explanation of Benefits (EOB) that defines what was paid by PHP and what is their payment responsibility to the provider.
Online Provider Remittance Look Up
For your reference, here is a listing of the fields found on the PRA statement and a description of what each field means.
Field Name | Description |
|---|---|
Procedure Code | CPT code or revenue code for the service provided. |
Date of Service | Date or Date Range for the service provided. |
Quantity | Number of Units requested for the Procedure Code. |
Billed Amount | Amount requested by the Provider. |
Network Amount | Amount provided by network repricer. |
Provider Responsibility | The amount the provider must write off in accordance with their provider contract as a result of discounts or fee schedule arrangements. The provider may not bill the member for these amounts. |
Withhold | The amount retained by PHP as a “Physicians Contingency Reserve” per the Provider’s Contract. |
COB | The amount paid by another insurance carrier. |
Deductible | The amount you may collect that applies to the member’s deductible per the Member Contract. |
Copay / Coinsurance | The amount you may collect that applies to the member’s copay or coinsurance liability per the Member’s Contract. |
Patient Responsibility | The amount you may collect from the member, in addition to the member’s liability for deductible, copay, and coinsurance. |
Adj. Code | The Adjustment Code for that claim line. The description of the code is printed at the end of the Provider Remittance Advice. |