Q&A: Receiving payments in SPR format

Q: How is a standard paper remittance (SPR) different from an electronic remittance advice (ERA)?

A: A paper Explanation of Benefits (EOB) from Medicare, called a standard paper remittance (SPR), would include information similar to that of an ERA. However, the format of these two RAs is different. HIPAA does not apply to SPRs. If the payment is sent in SPR format, it will not have the service line information like on an ERA. The institutional SPR is divided into two parts: the all-claims (AC) page and summary page. The AC page shows the payment adjudication information for each separate claim but will not show the line item services information.The summary page shows the totals of the fields for all claims listed in the AC section.

ERAs take less time to receive, process, and post payment or denial information than SPRs, because Medicare can post an ERA file directly to a provider’s system that managers the accounts. ERAs are sent in ASC X12 835 format version 5010A1, which is often referred to just as 835s, distinguishing them from an electronic claim as 837I or 837P.

For more information see The Contemporary Guide to Patient Financial Services.