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  • Podiatry > EmblemHealth Market Share Payment Remittance Advice Field Explanations

    Provider Name

    The "pay to" provider's name. Box 33 of the CMS 1500.

    Remit

    Remit number (number assigned to remittance statement).

    Check Number

    Check number.

    Check Date

    Check date.

    Servicing Provider

    Practitioner rendering the service. Box 31 of the CMS 1500.

    Provider License Number

    EmblemHealth provider ID.

    Patient Name

    Member name on claim (patient name).

    ID

    Member ID.

    Subscriber

    Name of member (policy holder).

    Case Number

    The number assigned to the first claim submitted.

    Initial Contact Date

    Date that triggers contact period. (Same as initial date of service.)

    Contact Point

    Point assignment for new patient encounter. Can include additional points earned for high-intensity patients even if those services are performed in subsequent months. This field is located between contact point and case amount field.

    Case Amount

    Initial case payment.

    Claim Number

    Claim number of submitted claim.

    Begin DOS

    Date of service on submitted claim.

    Procedure code

    CPT code.

    Modifier

    CPT modifier.

    Current Case Payment

    Amount reflected in check, which could be initial case payment, adjustments due to point value changes and/or adjustments due to additional RVU points assigned to a case.

    Prior Case Payment

    All payments excluding current case payment and initial case payment.

    Net Case Payment

    Current value of case payment. (Will also reflect payment deductions due to voided claims.)

    Provider Total

    Accumulation of all current case payments for each servicing provider.

    Affiliate Total

    Accumulation of all current case payments for each tax ID. Several servicing practitioner totals may make up the affiliate total.

    Page Totals

    Sum of current case payments on each page.

    Begin Recoupment Balance

    Starting balance of negative adjustments.

    Amount Recouped This Cycle

    Recoupment of negative adjustments for present cycle.

    New Recoupment Balance

    Outstanding balance after recoupment of present cycle.

    Amount Processed Current Cycle

    Sum of current case payments.

    Amount Recouped This Cycle

    Recoupment of balance from previous cycle.

    Check Amount

    Net dollar amount reflected in check.

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    Enter your e-mail address to receive a link to your subscriptions.

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    Glossary terms found on this page:

    An agreement in which a patient assigns to another party, usually a physician or hospital, the right to receive payment from a public or private insurance program for the service the patient has received.

    An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.

    The government agency responsible for administering the Medicare and Medicaid programs.

    The date on which a service was rendered.

    A permit (or equivalent) to practice medicine or a health profession that is: 1) issued by any state or jurisdiction in the United States and 2) required for the performance of job functions.

    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

    A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:

    • Doctor of medicine
    • Doctor of osteopathy
    • Dentist
    • Chiropractor
    • Doctor of podiatric medicine
    • Physical therapist
    • Nurse midwife
    • Certified and registered psychologist
    • Certified and qualified social worker
    • Optometrist
    • Nurse anesthetist
    • Speech-language pathologist
    • Audiologist
    • Clinical laboratory
    • Screening center
    • General hospital
    • Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes

    A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.

    An active member enrolled under an EmblemHealth group Certificate or an individual enrolled under a direct payment contract. A "retiree" may also be a subscriber under a group Certificate.

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