Remittance Line Item — Remittance • hcc

A single remittance line item within a member's payment record.

Usage

Remittance(
  reference = NA_character_,
  original = numeric(0),
  adjustment = numeric(0),
  payment = numeric(0),
  rate = NA_character_,
  aid = NA_character_,
  plan = NA_character_,
  reason = NA_character_,
  description = NA_character_,
  coverage = c(.Date(numeric(0L)), .Date(numeric(0L)))
)

Arguments

reference

<chr> RMR-02 Invoice/check reference number

original

<chr> RMR-05/RMR-06 Original amount before adjustment (when present)

adjustment

<chr> ADX-01 Adjustment amount; If negative, it is a recoupment

payment

<chr> RMR-04/RMR-05 Net payment amount for this period; negative = recoupment

rate

<chr> REF*18 Rate code (e.g., "957" = PACE rate)

aid

<chr> REF*ZZ California Medi-Cal aid code (e.g., "1H", "M1", "60")

plan

<chr> REF*ZZ Plan type; Composite aid_code;plan_type

1: primary/medical
2: pharmacy/state-only

reason

<chr> ADX-02 Adjustment reason code ("53" = prior period)

description

<chr> REF*ZZ Payment description (e.g., "Primary Capitation Dual", "Medi-Cal Only-State Only")

coverage

<DTM*582> Coverage period start and end date (YYYY-MM-DD)

Value

A <hcc::Remittance> S7 object

Details

Each Remittance corresponds to one RMR segment and its associated REF, DTM, and ADX segments within an ENT loop of an 820 transaction.