Appendix S
Remittance Advice Expenditure Reason Codes
General Provider
| Reason Code | Expenditure Reason | Description |
|---|---|---|
| 0018 | Prescriber Tool | |
| 0747 | RHC Rate Recon | Rural Health Center Rate Reconciliation Payment |
| 0748 | Risk Corridor |
Managed Care Organization (MCO)-Specific
| Audience | Reason Code | Expenditure Reason | Description |
|---|---|---|---|
| Colorado Access only | 0430 | KPI Incentive | KPI Incentive Payment |
| DentaQuest only | 0162 | Dental ASO-XIX | Dental Administrative Service Organization – Medicaid Payment |
| Denver Health HMO only | 0152 | DHH NEWBRN DLIV | Denver Health Medical Plan Newborn Delivery Payment |
| Denver Health HMO only | 0195 | Hep C Drug DHHA | Hep C Drug Payment – Denver Health Medical Plan |
| HMOs only | 0200 | HIPF Recon | Health Insurance Provider Fee – Capitation Adjustment for Provider Tax Liability |
| MCOs only | 0080 | Casualty | Casualty Payment |
| Rocky Mountain Health Plan HMO only | 0196 | Hep C Drug RMHP | Hep C Drug Payment – Rocky Mountain |
Last revised: 1/8/2025