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Appendix S

Remittance Advice Expenditure Reason Codes

 

General Provider

Reason CodeExpenditure ReasonDescription
0018Prescriber Tool 
0747RHC Rate ReconRural Health Center Rate Reconciliation Payment
0748Risk Corridor 

 

Managed Care Organization (MCO)-Specific

AudienceReason CodeExpenditure ReasonDescription
Colorado Access only0430KPI IncentiveKPI Incentive Payment
 
DentaQuest only0162Dental ASO-XIXDental Administrative Service Organization – Medicaid Payment
 
Denver Health HMO only0152DHH NEWBRN DLIVDenver Health Medical Plan Newborn Delivery Payment
Denver Health HMO only0195Hep C Drug DHHAHep C Drug Payment – Denver Health Medical Plan
 
HMOs only0200HIPF ReconHealth Insurance Provider Fee – Capitation Adjustment for Provider Tax Liability
 
MCOs only0080CasualtyCasualty Payment
 
Rocky Mountain Health Plan HMO only0196Hep C Drug RMHPHep C Drug Payment – Rocky Mountain

Last revised: 1/8/2025