HRA payments: quick, automatic reimbursements

We continue to automatically send medical payments and HRA reimbursements to providers. Our new enhancements eliminate the one-week lag between the processing of the medical plan portion and the HRA portion. Also, the HRA and medical payment are now associated with the same claim ID. This allows you to quickly identify remaining patient liability for faster balance billing.

The paper copies of remittance advices (R/As) have a new reason code for HRA members:

• The Medical R/A shows "HRM: Process as primary, forwarded to additional payer(s) Priority Health HRA." You will receive the HRA payment within seven business days from the Medical R/A.
• The HRA R/A has the reason code "HRO: HRA member liability from prior claim considered for HRA benefit." Member may still owe member liability for this claim. After you receive the HRA R/A, you may then bill the member the member liability.

When searching online for claim detail for a specific member, you’ll see the Medical and HRA claim payment detail within the same view. The Provider Remittance Summary now also provides detail for both (medical and HRA) checks. And the claim number is the same for both plans. We also include Patient Cost, HRA Paid and Patient Pays on the R/A. In the Patient Cost column, we’re providing additional information to help you break down the member’s liability portion into four categories — deductible, coinsurance, copay and disallowed.

Our claim data is updated nightly, which means you’ll be able to see nearly-real-time claim data for your HRA patients.

If you have any questions, contact your PAC directly or through the Provider Helpline at 616 942-4765 or 800 942-4765.

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