Professional Provider Claim Summary Enhancement

September 8, 2012

Effective Sept. 10, 2012, the type of service (TS**) field on the professional Provider Claim Summary (PCS) will be replaced with a reimbursement payment type (PAY) field. There will be a 3-digit value listed for each service line to indicate the reimbursement rate that was applied in relationship to the member’s policy type. A list of values and descriptions will be available in the Claims and Eligibility section.

Note: This change also applies to the Electronic Payment Summary (EPS); however, the Electronic Remittance Advice (ERA) is not impacted.