 ANSI/HL7 V3 CR, R4-2008 HL7 Version 3 Standard: Claims and Reimbursement, Release 4 02/20/2008 |
Content Last Edited: 2009-09-04T22:38:52
7.2 Storyboards
7.3 Application Roles
7.4 Trigger Events
7.5 Refined Message Information Models
7.6 Hierarchical Message Descriptions
7.7 Interactions
The Payment Advice is a mechanism for a Payor (organization that pays) or their agent to inform a Payee of a transfer of funds or creation of a manual cheque. Note that the Payment Advice may originate from the Adjudicator (agent of the Payor) and be sent to a Provider who is known as the Payee. The Payment Advice may also be sent to a third party organization such as a head office.
State Transition Diagram
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For details on the interpretation of this section, see the storyboard discussion in the Version 3 Guide.
To demonstrate how a Payment Advice Detail is submitted against a Payee account.
A Payment Advice is a description of a payment issued to a Payee or beneficiary by a Payor. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to the Payee.
A Payment advice is made up of 3 components: [1] previously submitted and adjudicated Invoices, [2] adjustments made by an adjudicator to adjudicated Invoices (e.g. retro adjustments, claw backs), and [3] non-invoice adjustments (e.g. professional fees paid on behalf of payee, garnishee).
A Payment Advice Summary does not include explicit references to previously adjudicated EOBs (Explanation of Benefits). Rather, it provides daily summaries of adjudicated EOBs only. The Payment Advice Detail, however, does include explicit references to previously adjudicated EOBs.
HC Payor, Inc. has a regular weekly payment cycle with all Providers that submit Invoices to their organization. Each Invoice defines who the Provider has designated as their Payee (the person or organization that will receive the funds). This is reviewed and confirmed during the adjudication process. Each adjudicated Invoice, for which a payment is required, is queued in HC Payor, Inc.'s system for the end of week payment run. At the end of the week, HC Payor, Inc. reviews their payment queue and sorts it by Payee. For each unique Payee, it generates a Payment Advice, detailing the payment.
For a specific Payee, ABC Co., HC Payor, Inc. determines which EOBs (Explanation of Benefits) are included in the payment. In addition, HC Payor, Inc. determines that there are no retroactive adjustments that need to be applied. Lastly, HC Payor, Inc. looks for miscellaneous items that need to be included on the Payment Advice. In this case, they confirm that there is still an outstanding garnishee order from the courts which instructs them to deduct 80% of the payment advice up to a total of $5,000 and remit this amount to the courts. The Payment Advice totals $500.00, and therefore, as the $5,000 limit has not been reached, HC Payor, Inc. includes a deduction of $400.00 on the Payment Advice, which now totals $100.00 ($500.00 - $400.00 garnishee) for ABC Co.
A Payment Advice message is created and queued for ABC Co., indicating the EFT reference number, the amount and date of the payment, and the Invoice references.
To demonstrate how a query for Payment Advice details is generated and submitted. A Payment Advice Query is used by a Provider to uncover discrepancies between their accounting of items (based on submitted Invoices) and what was included on the Payment Advice.
On June 12, a pharmacist/owner operating a pharmacy in a province in Canada receives notification from her provincial pharmacy association that a new professional fee for dispensing prescriptions to methadone patients covered under the provincial drug benefit program has been negotiated.
The previous contract for the fee expired on March 31 and the new fee will be retroactive to April 1. The new fee will come into effect on June 15 and the retroactive payment will be made on the regular payment on June 30.
On June 20, the pharmacist/owner generates a report from her Pharmacy Management System that details 749 prescriptions that would be eligible for the retroactive payment during the period April 1 to June 15. On June 30, the pharmacy retrieves its provincial drug benefit Payment Advice Summary from the adjudicator. The Payment Advice contains an entry that states that a retroactive payment has been made for 630 prescriptions for the period April 1 to June 15.
Using the Payment Advice Query message, the pharmacist requests the details of the 630 prescriptions that were included in the payment. Comparing the details of the two lists, the pharmacist is able to identify the 119 prescriptions that differ. Through conversation with the provincial drug benefit program, the issue is resolved and the 119 prescriptions are added to a subsequent Payment Advice.
To demonstrate how a Payment Advice Summary is submitted against a Payee account.
A Payment Advice is a description of a payment issued to a Payee or beneficiary by a Payor. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to the Payee.
A Payment advice is made up of 3 components: [1] previously submitted and adjudicated Invoices, [2] adjustments made by an adjudicator to adjudicated Invoices (e.g. retro adjustments, claw backs), and [3] non-invoice adjustments (e.g. professional fees paid on behalf of payee, garnishee).
A Payment Advice Summary does not include explicit references to previously adjudicated EOBs (Explanation of Benefits). Rather, it provides daily summaries of adjudicated EOBs only. The Payment Advice Detail, however, does include explicit references to previously adjudicated EOBs.
| Pymt Adv Summary Results, Gen |  FICR_IN700101UV01 |
HC Payor, Inc. has just received and processed an Invoice from Dr. Charlie Chopper, a practicing Dentist, for services provided to a patient, Adam Everyman, who has dental insurance coverage with HC Payor, Inc.
The Invoice submitted totalled $250.00 in services provided, and HC payor, Inc. provided Adjudication Results indicating that they would cover $200.00 with payment to be made to Dr. Chopper.
Under the plan guidelines for Adam Everyman's coverage with HC Payor Inc., the actual payment for benefits are made the same day as the benefit is determined, so during the 'end of day' processing at HC Payor Inc. a payment is made to Dr. Chopper via EFT (Electronic Funds Transfer). Note: EFT is not covered under the current scope of this domain.
A Payment Advice message is created and queued for Dr. Chopper indicating the EFT reference number and the amount and date of the payment.
HC Payor, Inc. has a policy of making semi-monthly payments to practitioners where the Payee of Invoices adjudicated during that semi-monthly period is a practitioner.
During the current period HC Payor, Inc. has adjudicated three Invoices where the Payee is Dr. Seth Stretcher. Two of these Invoices where received during the current period, and one was received in a prior period but adjudication was delayed pending a case review. During the current period, a reversal of a previously paid Invoice, where payment was made to Dr. Stretcher, was received by Dr. Stretcher and processed by HC Payor, Inc.
The benefit amounts for the three Invoices where respectively: $67.50, $350.00, and $212.35. The benefit amount of the reversed Invoice was $135.25.
During the period-end processing run, HC Payor, Inc. generated a cheque for Dr. Stretcher in the amount of $494.60, and a Payment Advice was created and queued for Dr. Stretcher indicating the cheque reference number, the amount ($494.60) and date of the payment, and the Invoice references to the paid Invoices ($629.85) and the amount of the adjustment ($135.25).
NOTE: Account adjustments include the crediting and debiting of the Payee's account by the Payor for such things as professional fees, adjustments to previously paid items and retroactive payments (e.g. they are adjusting the fee schedule retroactive to a specific date and giving the Payee more or less $$).
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For details on the interpretation of this section, see the discussion of application roles and their relationships in the Version 3 Guide.
An application that coordinates payments for healthcare services by generating and distributing Payment Advices in electronic or paper format, as well as detailed statements of the Financial Transactions included in the payment period.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that coordinates payments for healthcare services by generating and distributing Payment Advices in electronic or paper format, as well as detailed statements of the Financial Transactions included in the payment period.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that coordinates payments for healthcare services by generating and distributing Payment Advices in electronic or paper format, as well as detailed statements of the Financial Transactions included in the payment period.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that coordinates payments for healthcare services by generating and distributing Payment Advices in electronic or paper format, as well as detailed statements of the Financial Transactions included in the payment period.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that coordinates payments for healthcare services by generating and distributing Payment Advices in electronic or paper format, as well as detailed statements of the Financial Transactions included in the payment period.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that coordinates payments for healthcare services by generating and distributing Payment Advices in electronic or paper format, as well as detailed statements of the Financial Transactions included in the payment period.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that coordinates payments for healthcare services by generating and distributing Payment Advices in electronic or paper format, as well as detailed statements of the Financial Transactions included in the payment period.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that coordinates payments for healthcare services by generating and distributing Payment Advices in electronic or paper format, as well as detailed statements of the Financial Transactions included in the payment period.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application responsible for tracking (receiving) Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
The Payment Tracker is typically the Provider or Payee but could, as an example also be a head office accountant.
An application responsible for tracking (receiving) Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
The Payment Tracker is typically the Provider or Payee but could, as an example also be a head office accountant.
A Payment Manager, Detail will report Payment Advices at a detail level, including references to adjudicated invoices.
An application responsible for tracking (receiving) Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
The Payment Tracker is typically the Provider or Payee but could, as an example also be a head office accountant.
A Payment Manager, Summary will report Payment Advices at a summary level only (i.e. no references to adjudicated invoices).
An application responsible for tracking (receiving) Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
The Payment Tracker is typically the Provider or Payee but could, as an example also be a head office accountant.
An application responsible for tracking (receiving) Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
The Payment Tracker is typically the Provider or Payee but could, as an example also be a head office accountant.
A Payment Manager, Detail will report Payment Advices at a detail level, including references to adjudicated invoices.
An application responsible for tracking (receiving) Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
The Payment Tracker is typically the Provider or Payee but could, as an example also be a head office accountant.
An application responsible for tracking (receiving) Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
The Payment Tracker is typically the Provider or Payee but could, as an example also be a head office accountant.
A Payment Manager, Detail will report Payment Advices at a detail level, including references to adjudicated invoices.
An application responsible for tracking (receiving) Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
The Payment Tracker is typically the Provider or Payee but could, as an example also be a head office accountant.
An application responsible for querying details for Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application responsible for querying details for Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application responsible for querying details for Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application responsible for querying details for Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application responsible for querying details for Payment Advices.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that responds to a Payment Advice Query Request.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that responds to a Payment Advice Query Request.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that responds to a Payment Advice Query Request.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that responds to a Payment Advice Query Request.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
An application that responds to a Payment Advice Query Request.
A Payment Advice is a description of a payment issued to a Payee or beneficiary. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to a Payee.
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For details on the interpretation of this section, see the discussion of trigger events in the Version 3 Guide.
| Type: | State-transition based |
| State Transition: | Payment (FICR_RM700000UV01) |
A trigger to send a Payment Advice message to a Payee.
A Payment Advice is a description of a payment issued to a Payee or beneficiary by a Adjudicator. Payment refers to an actual cheque or Electronic Funds Transfer (EFT) issued to the Payee.
A Payment advice is made up of 3 components: [1] previously submitted and adjudicated Invoices, [2] adjustments made by an adjudicator to adjudicated Invoices (e.g. retro adjustments, claw backs), and [3] non-invoice adjustments (e.g. professional fees paid on behalf of payee, garnishee).
| Type: | User request |
A trigger to send a Payment Advice Query Request to inquire about a specific element in a Payment Advice that was previously received by the Payee.
For example, a Adjudicator sends a Payment Advice Summary with daily totals for the 2 week pay period. The Adjudicator indicates on one such day a daily total equalling $500.00, but the Payee believes there should have been $550.00 paid for the same time period. The Payee would then query the Adjudicator for the specific date in question. The Adjudicator would return the adjudicated invoices (EOBs) that made up the $500.00 in their query response. Therefore, the Payee could then determine where the problem exists.
| Type: | Interaction based |
A trigger to send a Payment Advice Query Response to notify the Payee of the Payment Advice information requested.
A Payment advice is made up of 3 components: [1] previously submitted and adjudicated invoices, [2] adjustments made by an adjudicator to adjudicated invoices (e.g. retro adjustments), and [3] non-invoice adjustments (e.g. professional fees paid on behalf of payee).
The Payment Advice Query Reponse will only include the adjudicated invoices (EOBs) that make up 1 specific element of a Payment Advice (e.g. 1 daily total) for component 1 or 2 above. Component 3 has no details and cannot be queried for additional details.
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For details on the interpretation of this section, see the description of RMIMs in the Version 3 Guide.
| Parent: | Claims & Reimbursement (FICR_DM000000UV03) |
This model represents a message used to send the Payment Advice Details message which provides the notification for payment information between an Insurance Carrier (e.g. jurisdictional medical services plan, insurance organization, workers compensation organization and/or their agents) and a Payee (designated on the Invoice) and optionally the healthcare product or services Provider (e.g. individual healthcare practitioner, healthcare facility, pharmacy, medical goods and supplies purveyors, etc.) who has submitted an Invoice. ).
An Insurance Carrier may delegate performance of this function to an Adjudicator (agent of the Insurance Carrier). Subsequent discussions only note Provider and Adjudicator (not Insurance Carrier).
A Payment advice is made up of references to 3 components: [1] previously submitted and adjudicated invoice Payment Intents, [2] adjustments made by an adjudicator to previously adjudicated invoices (e.g. retro adjustments) referencing their AdjudicationResultsGroups with a reference to the AdjudResultsInvoiceElementRef and [3] non-invoice adjustments (e.g. professional fees paid on behalf of payee) specified in new AdjudicationResultsGroups.
This Payment Advice Detail is differentiated by its reference to previous Payment Intents and the AdjudicationResultsGroups and the references to their supporting AdjudicatedInvoiceElementGroup, AdjudicationResult and InvoiceElementGroup that had been communicated as part of adjudication processing.
If a Payment Advice is paid by cheque, it typically has a 1 to 1 correspondence with a cheque number. However, there are occasions when 1 cheque number covers multiple Payment Advices. This message does not enforce a 1 to 1 relationship between cheque number and Payment Advice. That is, the same cheque number (Cheque Number on PMT) can be used on multiple Payment Advices. This also applies to other forms of payment.
If a Payee is a person and not an organization, then a Payment Advice may not be generated by the Payor.
| Payment Advice Detail | FICR_HD710100UV01 |
| Parent: | Claims & Reimbursement (FICR_DM000000UV03) |
This model represents a message used to send the Payment Advice Summary message which provides the notification for payment information between an Insurance Carrier (e.g. jurisdictional medical services plan, insurance organization, workers compensation organization and/or their agents) and a Payee (designated on the Invoice) and optionally the healthcare product or services Provider (e.g. individual healthcare practitioner, healthcare facility, pharmacy, medical goods and supplies purveyors, etc.) who has submitted an Invoice. ).
An Insurance Carrier may delegate performance of this function to an Adjudicator (agent of the Insurance Carrier). Subsequent discussions only note Provider and Adjudicator (not Insurance Carrier).
A Payment advice summary is made up of references to 3 components: [1] previously submitted and adjudicated invoice Payment Intents, [2] adjustments made by an adjudicator to previously adjudicated invoices (e.g. retro adjustments) referencing their AdjudicationResultsGroups with a reference to the AdjudResultsInvoiceElementRef and [3] non-invoice adjustments (e.g. professional fees paid on behalf of payee) specified in new AdjudicationResultsGroups.
For components [1] and [2], the summary Payment Advice does not include the actual references to the adjudicated invoices (EOBs) but only the AdjudicationResultsGroups.
The Payment Advice may also list Bank Account data to indicate where the funds were deposited (for EFT payment advices).
| Payment Advice Summary | FICR_HD700100UV01 |
| Parent: | Claims & Reimbursement (FICR_DM000000UV03) |
This model represents a message used to send a Payment Advice Query Request message from a Provider (e.g. individual practitioner, healthcare facility, medical goods and supplies purveyor) to an Insurance Carrier (e.g. jurisdictional medical services plan, insurance organization, workers compensation organization).
An Insurance Carrier may delegate performance of this function to an Adjudicator (agent of the Insurance Carrier). Subsequent discussions only note Provider and Adjudicator (not Insurance Carrier).
It is used to request the details of a Payment Advice Summary. Only 1 specific element in the Payment Advice can be requested with this query.
The Payment Advice Query is a single parameter, the Invoice Element root Group identifier, from the Payment Advice Summary being queried.
The Payment Advice Query Results message is returned in response to this query containing the only the requested information. Only a previously submitted and adjudicated invoice Payment Intents and adjustments can be queried.
A response to a Payment Advice Query is made up of references to 2 possible component types: [1] a previously submitted and adjudicated invoice Payment Intent AdjudicatedInvoiceElementGroups and their supporting details, [2] adjustments made by an adjudicator to previously adjudicated invoices (e.g. retro adjustments) referencing their AdjudicationResultsGroups with a reference to the AdjudResultsInvoiceElementRef.
| Payment Advice Query Request | QUCR_HD720100UV01 |
| Parent: | Claims & Reimbursement (FICR_DM000000UV03) |
This model represents a message used to respond to a Payment Advice Query message from a Provider (e.g. individual practitioner, healthcare facility, medical goods and supplies purveyor) to an Insurance Carrier (e.g. jurisdictional medical services plan, insurance organization, workers compensation organization).
An Insurance Carrier may delegate performance of this function to an Adjudicator (agent of the Insurance Carrier). Subsequent discussions only note Provider and Adjudicator (not Insurance Carrier).
It provides the details supporting a Payment Advice Summary.
A Payment Advice Query Response is made up of references to 2 possible component types (EOBs): [1] a previously submitted and adjudicated invoice Payment Intent AdjudicatedInvoiceElementGroups and their supporting details, [2] adjustments made by an adjudicator to previously adjudicated invoices (e.g. retro adjustments) referencing their AdjudicationResultsGroups with a reference to the AdjudResultsInvoiceElementRef.
For example, an Adjudicator sends a Payment Advice Summary with daily totals for the 2 week pay period. The Adjudicator indicates on one such day a daily total equaling $500.00, but the Payee believes there should have been $550.00 paid for the same time period. The Payee would then query the Adjudicator for the specific date in question. The Adjudicator would return the adjudicated invoices (EOBs) that made up the $500.00 in their query response. Therefore, the Payee could then determine where the problem exists.
| Payment Advice Query Results | QUCR_HD730100UV01 |
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For details on the interpretation of this section, see the description of HMDs in the Version 3 Guide.
This message is used to send a payment advice detail to a Payee for the notification of payments for Invoices (referenced) and/or other financial adjustments.
If a Payee is a person and not an organization, then a Payment Advice may not be generated by the Payor.
This message is used to send a payment advice summary to a Payee for the notification of payments for Invoices and/or other financial adjustments.
If a Payee is a person and not an organization, then a Payment Advice may not be generated by the Payor.
The Payment Advice Query is used to request the details ofa Payment Advice. Only 1 specific element in the Payment Advice can be requested with one query.
The Payment Advice Query is a single parameter, the Invoice Element root Group identifier, from the Payment Advice Summary being queried.
The Payment Advice Query Results message is returned in response to this query.
The Payment Advice Query Response provides the detail for a specified portion of a Payment Advice.
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For details on the interpretation of this section, see the definition of Interactions in the Version 3 Guide.
The sender sends a Payment Advice Detail message for Chiro Physio services and/or products.
The Payment Advice Detail message details a payment made to a Payee for previously adjudicated Invoices plus any adjustments.
Payment details include references to the adjudicated Invoices.
| Trigger Event | Payment Advice Notification | FICR_TE700101UV01 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Payment Advice Event Complete Detail | FICR_MT710101UV01 |
| Sender | Payment Advice Mgr, ChiroPhysio | FICR_AR070004UV02 |
| Receiver | Payment Advice Tracker, ChiroPhysio | FICR_AR071004UV02 |
The sender sends a Payment Advice Detail message for Generic services and/or products.
The Payment Advice Detail message details a payment made to a Payee for previously adjudicated Invoices plus any adjustments.
Payment details include references to the adjudicated Invoices.
| Trigger Event | Payment Advice Notification | FICR_TE700101UV01 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Payment Advice Event Complete Detail | FICR_MT710101UV01 |
| Sender | Payment Advice Mgr, Gen | FICR_AR070001UV01 |
| Receiver | Payment Advice Tracker, Gen | FICR_AR071001UV01 |
The sender sends a Payment Advice Detail message for Oral Health services and/or products.
The Payment Advice Detail message details a payment made to a Payee for previously adjudicated Invoices plus any adjustments.
Payment details include references to the adjudicated Invoices.
| Trigger Event | Payment Advice Notification | FICR_TE700101UV01 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Payment Advice Event Complete Detail | FICR_MT710101UV01 |
| Sender | Payment Advice Mgr, OralHealth | FICR_AR070005UV03 |
| Receiver | Payment Advice Tracker, OralHealth | FICR_AR071005UV03 |
The sender sends a Payment Advice Detail message for medical services and/or products rendered by a physician.
The Payment Advice Detail message details a payment made to a Payee for previously adjudicated Invoices plus any adjustments.
Payment details include references to the adjudicated Invoices.
| Trigger Event | Payment Advice Notification | FICR_TE700101UV01 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Payment Advice Event Complete Detail | FICR_MT710101UV01 |
| Sender | Payment Advice Mgr, Physician | FICR_AR070007UV03 |
| Receiver | Payment Advice Tracker, Physician | FICR_AR071007UV03 |
The sender sends a Payment Advice Detail message for Preferred Accommodation services and/or products.
The Payment Advice Detail message details a payment made to a Payee for previously adjudicated Invoices plus any adjustments.
Payment details include references to the adjudicated Invoices.
| Trigger Event | Payment Advice Notification | FICR_TE700101UV01 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Payment Advice Event Complete Detail | FICR_MT710101UV01 |
| Sender | Payment Advice Mgr, PAccom | FICR_AR070003UV01 |
| Receiver | Payment Advice Tracker, PAccom | FICR_AR071003UV01 |
The sender sends a Payment Advice Detail message for Vision Care services and/or products.
The Payment Advice Detail message details a payment made to a Payee for previously adjudicated Invoices plus any adjustments.
Payment details include references to the adjudicated Invoices.
| Trigger Event | Payment Advice Notification | FICR_TE700101UV01 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Payment Advice Event Complete Detail | FICR_MT710101UV01 |
| Sender | Payment Advice Mgr, VisionCare | FICR_AR070006UV03 |
| Receiver | Payment Advice Tracker, VisionCare | FICR_AR071006UV03 |
The sender sends a Payment Advice Summary message for Generic services and/or products.
The Payment Advice Summary message summarizes a payment made to a Payee for previously adjudicated Invoices plus any adjustments.
Payment information does NOT include references to the adjudicated Invoices.
| Trigger Event | Payment Advice Notification | FICR_TE700101UV01 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Payment Advice Event Complete Summary | FICR_MT700101UV01 |
| Sender | Payment Advice Mgr, Gen | FICR_AR070001UV01 |
| Receiver | Payment Advice Tracker, Gen | FICR_AR071001UV01 |
The sender sends a Payment Advice Summary message for Pharmacy services and/or products.
The Payment Advice Summary message summarizes a payment made to a Payee for previously adjudicated Invoices plus any adjustments.
Payment information does NOT include references to the adjudicated Invoices.
| Trigger Event | Payment Advice Notification | FICR_TE700101UV01 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Payment Advice Event Complete Summary | FICR_MT700101UV01 |
| Sender | Payment Advice Mgr, Rx | FICR_AR070002UV01 |
| Receiver | Payment Advice Tracker, Rx | FICR_AR071002UV01 |
The sender sends a Payment Advice Query message to determine the status of a specific payment component from a Payment Advice previously received by the Payee for Generic services and/or products.
| Trigger Event | Payment Advice Query | QUCR_TE720101UV01 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Query Control Act Request : Parameter List | QUQI_MT020001UV01 |
| Query Definition | Payment Advice Event Query Request | QUCR_MT720101UV01 |
| Reason | Trigger Event | Interaction |
| Payment Advice Query Response | QUCR_TE730101UV01 | QUCR_IN730101UV01 |
| Sender | Payment Advice Rqstr, Gen | FICR_AR072001UV01 |
| Receiver | Payment Advice Query Mgr, Gen | FICR_AR073001UV01 |
The sender sends a Payment Advice Query message to determine the status of a specific payment component from a Payment Advice previously received by the Payee for Pharmacy services and/or products.
| Trigger Event | Payment Advice Query | QUCR_TE720101UV01 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Query Control Act Request : Parameter List | QUQI_MT020001UV01 |
| Query Definition | Payment Advice Event Query Request | QUCR_MT720101UV01 |
| Reason | Trigger Event | Interaction |
| Payment Advice Query Response | QUCR_TE730101UV01 | QUCR_IN730102UV01 |
| Sender | Payment Advice Rqstr, Rx | FICR_AR072002UV01 |
| Receiver | Payment Advice Query Mgr, Rx | FICR_AR073002UV01 |
The sender sends a Payment Advice Query Response message to detail the status of a specific payment component from a Payment Advice previously received by the Payee for Generic services and/or products.
Payment details include references to the adjudicated Invoices.
| Trigger Event | Payment Advice Query Response | QUCR_TE730101UV01 |
| Transmission Wrapper | Application Level Acknowledgement | MCCI_MT000300UV01 |
| Control Act Wrapper | Query Control Act Response / Acknowledgement | QUQI_MT120001UV01 |
| Query Definition | Payment Advice Event Query Response | QUCR_MT730101UV01 |
| Sender | Payment Advice Query Mgr, Gen | FICR_AR073001UV01 |
| Receiver | Payment Advice Rqstr, Gen | FICR_AR072001UV01 |
The sender sends a Payment Advice Query Response message to detail the status of a specific payment component from a Payment Advice previously received by the Payee for Pharmacy services and/or products.
Payment details include references to the adjudicated Invoices.
| Trigger Event | Payment Advice Query Response | QUCR_TE730101UV01 |
| Transmission Wrapper | Application Level Acknowledgement | MCCI_MT000300UV01 |
| Control Act Wrapper | Query Control Act Response / Acknowledgement | QUQI_MT120001UV01 |
| Query Definition | Payment Advice Event Query Response | QUCR_MT730101UV01 |
| Sender | Payment Advice Query Mgr, Rx | FICR_AR073002UV01 |
| Receiver | Payment Advice Rqstr, Rx | FICR_AR072002UV01 |
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