Medicare Services has received several inquiries from providers requesting clarification of the new reason codes for adjustments and offsets that are included on the Standard Paper Remittance (SPR) advice. The crosswalk below should provide assistance.

Because the "MSP" and "Paid to Beneficiary" fields were eliminated, such claim payment adjustments are being reported at the bottom of the claim detail with reason code "CS." This will be corrected July 1, 2002, at which time, the "MSP" and "Paid to Beneficiary" information will be reported in the "Total RC-AMT field." To determine the type of claim adjustment made, refer to the remarks codes. For example, OA-71indicates a primary payment and CO-A3 indicates that Medicare is secondary.

Another issue that has arisen because of the changes to the SPR is the reconciliation of the remittance advice for MSP claims. Because of these changes, the amount indicated in the PROV PD field does not represent the actual amount paid to the provider. To obtain the correct amount paid on the claim, take the amount in the PROV PD field and subtract the amount at the end of the register under PROVIDER ADJ DETAILS with a CS reason code. To rectify this situation, we will be implementing changes to the SPR July 1, 2002, so that this information is clearer. Please refer to the examples that indicate how the revised SPR will more accurately indicate claim payments.

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