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REMITTANCE ADVICE
3.2.1
EFT Notification Page Field Descriptions
Upper Left Corner
Provider’s Name (as recorded in the Medicaid files)
Upper Right Corner
Date: The date on which the remittance advice was issued
Remittance Number
PROV ID: This field will contain the Medicaid Provider ID and the NPI
Center
Medicaid Provider ID/NPI/Date
Provider’s Name/Address
Provider’s Name – Amount transferred to the provider’s account. This amount must equal the Net Total Paid Amount
under the Grand Total subsection plus the total sum of the Financial Transaction section.
CLINICAL SOCIAL WORKER
Version 2010 - 01
11/18/2010
Page 35 of 59