18.4.65 EHC^E15 - Payment/Remittance Advice (event E15) (16.3.9)

This message is used to send a payment/ remittance advice to a Payee for the payment of HealthCare Services Invoices and/or other adjustments. The Payment/Remittance Advice can be sent to the originating Provider Application (Network Application ID) or alternately to the Payee's Network Application ID, depending on how the Payee has been configured by the Payer. If a Payment/Remittance Advice is paid by check, it typically has a 1 to 1 correspondence with a check number. However, there are occasions when one check number covers multiple Payment/Remittance Advices. This message does not enforce a 1 to 1 relationship between check number and Payment/Remittance Advice. That is, the same check number (Check Number on PMT) can be used on multiple Payment/Remittance Advices.

A Payment/Remittance Advice may not be generated if a Payee is a Person and not an organization (Payee Type on PYE = "PERS" or "PPER").

Once an EHC^E15 message is prepared (which may be on a regular basis such as monthly or bi-weekly), it is either sent to the Provider Application (if the Provider Application is able to receive unsolicited results) or stored on a queue for the Provider Application. If left on a queue for the Provider Application, then the QBP^E99 message must be used by the Provider Application to poll the Payer Application for the EHC^E15.

Processing Rules:

• The Provider Application and the Payer Application must uniquely identify each Invoice, Product/Service Group, Product/Service Line Item and Adjustment. These numbers appear as a pair on the IVC, PSG, PSL and ADJ segments and must be echoed on any subsequent interactions for the Invoice, group or line item between the Provider Application and Payer Application.

• The Provider Application and/or Payer Application may also supply a tracking number for each Product/Service Line Item it processes, specified as the Provider Tracking Number or Payer Tracking Number.The Provider Tracking Number and Payer Tracking Number must be echoed on any subsequent interactions for the Product/Service Line Item between the Provider Application and Payer Application.

• The Payer Application must uniquely identify each Payment/Remittance Advice. The unique Payment/Remittance Advice identifier must be specified as Payment/Remittance Advice Number on PMT.

• At least one of Payment/Remittance Detail Information or Adjustment(s) to Payee block must be specified with this message (see EHC^E15 - Message Summary for details) to describe the details of the Payment/Remittance Advice.

• The Payment/Remittance Amount on PMT must equal to the sum of all Adjudicated/Paid Amount for all IPR segments PLUS the sum of all Adjudication/Paid Amounts for all ADJ segments in the Payment/Remittance Advice, excluding information adjustment types (Adjustment Category on ADJ = "IN").