Reading the R&S Report
The Four Sections of R&S Reports
1. Pending Claims are: (1) claims still going through TMHP edits or (2) claims that
have passed TMHP edits, been sent on to the state and TMHP is waiting for
warrant/direct deposit information from the Comptroller.
2. Non-Pending Claims are claims that have finalized in either a paid or denied
status.
3. EOB Codes and Descriptions are the explanation of benefits codes that describe
the status of the claim. For pending claims, the EOB code is not the final
disposition of the claim. Non-pending claims that paid have an EOB code of
F0238 (This line item is approved to pay) while a claim that denied will have
EOB codes describing the reason for denial. An EOB code of F0239 in a nonpending claim means they were paid an amount different than what was billed for
that claim. (The EOB codes and descriptions will be reflected on the LTC
supplemental Claims Activity Report.)
4. Financial Summary gives summary information for expedited payments,
administrative payments, provider total deductions, provider monthly deductions,
and warrant/direct deposits.
Report Heading Fields for Non-Pending 835 Sections
PROVIDER NO. is the nine-digit long-term care provider number. One R&S report is
issued for each provider number.
PIN is the Payee Identification Number assigned by the Comptroller's office to an
individual or entity to disperse funds.
REPORT DATE is a unique number assigned to each report, usually in year, month, day
format.
WARRANT AMOUNT is the total of warrant(s) for the Non-Pending claims on the
R&S report.
WARRANT NO. is a unique number assigned by the Comptroller's Office when the
warrant is issued.
WARRANT Date is the date the Comptroller's Office issued the warrant.
Examples of R&S Dates:
R&S reports include claims processed during a weekly period. The cutoff time for R&S
reports is 6 p.m. on Fridays. However, due to variables in processing, claims entered any
later than roughly 12 hours before the cutoff time (i.e. 6 a.m. Friday), may not appear
until the next R&S report.
When generating an R&S report for a week, enter a Friday for an R&S Start Date and a
Monday for an R&S End Date in the "Generate R&S Report" window. The start and end
dates span a weekend. The R&S report will list claim activity for the week prior to the
start date. For example, if entering 10/10/2003 (a Friday) for a start date, and 10/13/2003
(the following Monday) for an end date, the R&S report would list claim activity from
Friday, 10/06/2003 to Friday, 10/10/2003.
Note: TMHP recommends that R&S reports be retrieved and generated on a weekly
basis.
Fields in R&S Claim Headings
CLIENT NAME is the name of the client in last name, first name order.
CLIENT/MEDICAID NO./TRAINEE is the nine-digit client/Medicaid number or
social security number of trainee if the claim is for Nurse Aide Training.
CLIENT CONTROL NO. is the client control number (patient account number), which
is NOT the same as the client/Medicaid number. This field is required and the provider
decides what value to give it. Its main function is to give providers a field they can use to
track claims in a manner they choose. This field is not edited or checked by TMHP.
ICN is the Internal Control Number assigned by TMHP, a number unique to each claim,
which serves as a serial number to identify a specific claim.
TOTAL BILLED is the total dollar amount billed.
TOTAL PAID is the actual total dollar amount paid.
Fields in R&S Claim Line Items
SRVC DATES
Begin Dt/End Dt. The first date is the beginning date of the service being billed, and the
second date is the ending date of that service. Both dates are in year, month, day format.
PROC CD/REV CD
Procedure code/revenue code. This field is the procedure code and/or revenue code used
on the claim.
MOD1, MOD2, MOD3, MOD4
Modifiers. This field is any required modifiers that were used on the claim.
BILLED UNITS/PAID UNITS
Units is a stacked field. The top field lists how many units were billed on the line item,
and the bottom field shows actual units paid for that line item.
ADJ AMT1/ADJ AMT2
Adjustment Amount Reflect the amount(s) for any adjustments or negative billing.
BILLED AMOUNT/PAID AMOUNT
Billed/Paid amounts is a stacked field. The top number is the dollar amount billed on the
claim. The second is the actual dollar amount paid on the claim.
REMARK1/REMARK2
Explanation of Payment Reflects the reason the claim denied or paid the amount/units
that were paid.
Financial Summary Page
Type of Financial Action Information:

The TOTAL AMOUNT field is the sum of all payments to the provider, of a
particular type that have not been repaid to the state. For example, if a provider
had received five administrative payments of $20,000 each totaling $100,000, and
had completely repaid three administrative payments totaling $60,000, then the
amount field would be $40,000 because two payments had not been repaid.

The TOTAL WITHHELD TO DATE field lists the total that the provider has
satisfied toward the total shown in the TOTAL AMOUNT field. Using the
example above, if the provider still had two outstanding administrative payments
of $20,000 each that total $40,000, and had paid $10,000 toward one and nothing
toward the other, then the withheld amount would be $10,000, because $10,000
had been paid toward administrative payments that were not paid off. Again,
withheld amount relates ONLY to payments not fully paid back. Any monies paid
toward prior payments that have been completely paid back will not be reflected.

The TOTAL WITHHELD THIS R&S field lists the total amount withheld on
the current R&S report.
Warrant Information
The "Warrant Information for this Report" field displays all warrant information received
during the current reporting period. This warrant information affects claims appearing on
the Non-Pending 835 report. The total of these warrants minus any amounts recouped for
this period should equal the sum of the paid claims appearing on the Non-Pending Claims
section.
Reconciling The R&S Report
Each week when downloading the R&S report, it is necessary to reconcile the claims
appearing on the Non-Pending 835 report against warrants appearing on the Financial
Summary report. The following steps will accomplish this:
1. Add up all amounts appearing in the Total Paid field of the Non Pending 835
report.
2. Add up all amounts appearing in the Total Amount Paid field on the Financial
Summary report - Warrant Information section.
3. These two totals should equal each other. If they do not, go to step 4.
4. Retrieve the Financial Summary page from the PREVIOUS R&S. Add all
amounts appearing in the Withheld Amount column of the Financial Summary –
Type of Financial Action section. Repeat this for the Financial Summary page of
the CURRENT R&S.
5. Subtract the previous R&S Withheld Amount total from the current R&S
Withheld Amount total. This is the total amount recouped from the current R&S.
This amount should equal the difference between the totals of the warrants issued
and paid claims appearing on the Non Pending R&S.