Reports from HMSA
HMSA regularly sends claims-related reports to providers, as described below.
Report to Provider (RTP)
The RTP is a weekly report mailed to providers with their checks. The RTP summarizes claims status and is useful in posting payments. Do not use RTPs to make claims modifications and corrections or to submit additional information needed to reprocess a claim.
*RTPs are going paperless! If you receive electronic payments, we are changing the way you receive your Report to Provider (RTP). Your RTPs will no longer be mailed to you and will now be accessible online through HHIN+. If you have questions or do not have RTP access on HHIN+, please contact us at (808) 948-6255 or via email ETSOutreach@hmsa.com.
Claims in Process
Claims for which HMSA needs additional time or information to process are listed as "Claims in Process" on the RTP. Refer to the sample Report to Provider.
Notification Report
A notification report informs providers that HMSA needs additional time to complete the processing of specific claims. Notification reports are sent on a daily basis. Typical reasons include:
- HMSA is waiting for a membership update from the member or member's employer group to determine the patient's eligibility on the date of service.
- HMSA's responsibility for primary coverage cannot be determined because the member has not returned the dual coverage/dual membership form to HMSA.
- The member has not returned the injury/illness or subrogation form to HMSA if a workers' compensation or motor vehicle insurance claim might be involved.
Note: Information contained in the notification report also is included in the RTP. Refer to the sample Notification Report.
Acknowledgment File
An acknowledgment file is available to view or download by providers and/or vendors to confirm the receipt of each EDI transmission file. The acknowledgment file shows the number of claims and total charges submitted, as well as whether the file format for the batch of claims is correct or if any required records are absent.
Acknowledgment files are usually handled by the facility's information systems personnel. Refer to the sample Acknowledgment Report.
Claims Rejected to Provider
Claims Rejected to Provider is a report that notifies the provider of any basic problems with EDI claims, such as invalid provider number, member number, service dates and revenue codes. This report is mailed to the provider within five working days of the facility's transmission.
Any claim appearing on the Claims Rejected to Provider report is not accepted as a valid claim because key information is missing or erroneous. The claim must be corrected and submitted as a new claim (using the original type of bill). Refer to the sample Claims Rejected to Provider report.
Form 97
Form 97s are sent to the provider when key information on the EDI or original UB-04 is missing or invalid. The checklist format indicates what is needed for the claim to be accepted. The form letter also provides instructions for how and where to resubmit the requested information.
Refer to the sample, effective August 1, 2013, Form 97 - Unable to Process Claims.
