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With each check you will receive a Provider Remittance Advice (PRA), which is a statement explaining the services that are being paid.  Similarly, patients receive an Explanation of Benefits (EOB) that defines what was paid by PHP and what is their payment responsibility to the provider.

Download a sample PRA

Online Provider Remittance Look Up

For your reference, here is a listing of the fields found on the PRA statement and a description of what each field means.

Field Name

Description

Procedure Code

CPT code or revenue code for the service provided.

Date of Service

Date or Date Range for the service provided.

Quantity

Number of Units requested for the Procedure Code.

Billed Amount

Amount requested by the Provider.

Network Amount

Amount provided by network repricer.

Provider Responsibility

The amount the provider must write off in accordance with their provider contract as a result of discounts or fee schedule arrangements. The provider may not bill the member for these amounts.

Withhold

The amount retained by PHP as a “Physicians Contingency Reserve” per the Provider’s Contract.

COB

The amount paid by another insurance carrier.

Deductible

The amount you may collect that applies to the member’s deductible per the Member Contract.

Copay / Coinsurance

The amount you may collect that applies to the member’s copay or coinsurance liability per the Member’s Contract.

Patient Responsibility

The amount you may collect from the member, in addition to the member’s liability for deductible, copay, and coinsurance.

Adj. Code

The Adjustment Code for that claim line. The description of the code is printed at the end of the Provider Remittance Advice.