At the beginning of each month, usually the first week, the Ministry of Health will send out a Remittance Advice file to show you the amount you will be paid by the MOH. This tutorial will show you how CabMD retrieves this file, and applies it to your CabMD account so you can see how your claims were paid. To see the steps a claim takes, please view THIS FAQ as well.
Remittance Report Summary
In the EDT File section of CabMD (found by going under File Centre > EDT Files) you can see all of the files CabMD has downloaded and uploaded to the MOH. You can sort these columns by selecting the Funnel Icon to the right of the headings.
You can filter the File Type to "Remittance" and this will show you only remittance files.
To the left of the file, you will see two icons. The first is a green down arrow. This will allow you to download the file to your computer. The second, is an icon that is a magnifying glass over a piece of paper. If you click on this, a new window will open with your RA File Summary.
This will show you your payable amount, which is the amount the MOH will deposit into your bank account. It also has the date in which this deposit will be made. Below that, you will see a section titled "Accounting Transactions". This will contain all of the adjustments the ministry has made to your payment. Anything that is in ()s are deductions, and everything without brackets will be additions. Below that is a break down of your year to date and bonuses. Age premiums will also appear down here, and they will be broken up into the different age premiums.
In the Report section of CabMD, you can view your Paid Claims Report (Detailed) after you receive your RA file. This will show you an in depth description of your claims that were paid on your RA file. CabMD reads your RA file and organizes the claims into the Paid section. The details of the claims will then be presented with a full break down of each service code.
The start date and end date are automatically set for the current month. Make sure the start date and end date include the date in which the RA was download into CabMD. You can check the date by looking at the transfer date in your EDT files. If the amount is in black ink, the claim was paid in full. If the amount is in red, it means there was an adjustment made by the MOH for this claim. To the far right, there is an explanatory code column. To find out what these mean, at the very end of the report (last page) there is a legend that will show the explanatory codes and what they mean.
In your paid section, you can have a quick look at the claims that have been paid. You can also filter the claims and see how they were paid.
You can filter the paid claims by either patient name, health card or claim #. If you roll the mouse over the status icons (Green file or red $) and it will give you a detailed explanation of how the claim was paid. Moving your mouse of the date will show the submission history of the claim. Moving your mouse over the accounting #, you will see the service information (diagnostic code, service location, etc).
If you move your mouse over a red $ icon for an adjustment, it will tell you what the claim was billed for and how much was paid. It will also include an explanatory code and the adjustment code.
If you wish to file an RA inquiry, you can do so in the Paid section by clicking on the green trillium icon on the far left. This will open a new window for generating an RA Inquiry. Select the service code you wish to inquire about, and then select if you feel you were underpaid or overpaid. In your remarks, write a detailed reason as to why you feel your payment was incorrect. If you want to report several codes, choose one code for the first drop down menu, but then include the other service codes in the remarks with detailed information about each code. The form will contain all of the codes. When you are finished, click the 'Generate' button to create the RA Inquiry.