Remittance advices for January care management checks are being delivered late

Remittance advices (RAs) for our January 2025 care management (CM) payment checks are being delivered late. Checks have already been delivered.

Background

We have a unique process for paying G-code and telephone visit CM services to prevent member cost share for fully-funded commercial, Medicare and Medicaid members.

1. Practices bill CM G-codes and telephone visit CPT services with their practice charges.
2. Priority Health auto-adjudicates claims, applying a $0 payment. On the RA, the $0 payment yields full allowed dollars as provider liability. The RA processing code is either Q11 or CO96, "no compensation allowed for this service - reporting only." The member's claim explanation displays $0 member liability; no copayment or deductible applies.
3. Every 60 days, we batch a payment for the full allowed amount of each practice's billed G-codes and CPT codes with no member copayment or deductible.

These payments are processed "offline" with a paper check. The check payment and RA are mailed to the provider's address. The RA includes claim details like member demographics, billed codes and date of service.

RAs delayed, coming soon

CM payment checks and RAs are usually sent together, but this month, the checks were sent before the RAs could be added to them. These RAs are in the process of being sent out, and practices will receive them soon.