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Appendix S

Remittance Advice Expenditure Reason Codes

 

General Provider

Reason CodeExpenditure ReasonDescription
0070CapitationCapitation Payment
0247EHR PaymentElectronic Health Record Payment
0292FQHC OutstationFederally Qualified Health Center Outstationing Payment
0340GME - InpatientGraduate Medical Education payment for inpatient managed care utilization
0345GME-OutpatientGraduate Medical Education payment for outpatient managed care utilization
0350OutptCostSettlmOutpatient Cost Settlement Payment
0390Incentive ExpIncentive Expenditure
0545No Payr Inf-RefNo Payor Information - Refund to provider for paper check received via mail. This may be due to one of the following circumstances: The claim was already denied, the claim was already adjusted, or the check received could not be matched to a claim. Contact the Provider Services Call Center for assistance and further details on claims status.
0650OtherOther (Contact the Provider Services Call Center for assistance and further details on claims status.)
0670OverpaymentOverpayment
0747RHC Rate ReconRural Health Center Rate Reconciliation Payment

 

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