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STATE OF HAWAII DEPARTMENT OF HUMAN SERVICES MED-QUEST DIVISION Companion Document and Transaction Specifications for the HIPAA 835 Claims Remittance Advice Transaction VERSION 1.4 MARCH 2004 DRAFT
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How to fill out hi 835 ra companion:

01
Start by gathering all the necessary information, including the patient's name, insurance information, and claim details.
02
Begin by completing the header section of the hi 835 ra companion form. This includes entering the provider's name and address, as well as the payer's name and address.
03
Move on to the patient information section and fill in the patient's name, address, and other relevant details.
04
Next, enter the insurance information, including the insurance company's name and address, as well as the policy or group number.
05
Proceed to fill out the claim details section, which includes the claim number, service dates, and the type of service provided.
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Provide a thorough description of the service rendered, including any procedures performed or medications administered.
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Ensure that all required fields are completed accurately and legibly.
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Double-check the completed form for any errors or missing information before submitting it.

Who needs hi 835 ra companion:

01
Healthcare providers who submit insurance claims and need to provide additional information or supporting documentation alongside the hi 835 RA (Remittance Advice) form.
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Patients who require a detailed breakdown of their insurance claim and need to understand the reimbursement process.
03
Insurance companies and payers who receive the hi 835 RA form and require the companion document to better understand the claim and make accurate reimbursements.
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The hi 835 ra companion is a form used for reporting information related to certain financial transactions.
Entities engaging in specified financial transactions are required to file the hi 835 ra companion form.
The hi 835 ra companion form can be filled out electronically or manually following the instructions provided by the relevant authority.
The purpose of the hi 835 ra companion form is to provide detailed information about financial transactions for regulatory and compliance purposes.
The hi 835 ra companion form requires reporting of specific details about the financial transactions, including amounts, dates, and parties involved.
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