7 Claims and Payment - Premera Blue Cross

Premera Dental Reference Manual
Premera Blue Cross Blue Shield of Alaska
SORA Explanation
Field Name
A Patient Name Patient (member) name.
Subscriber # & PT Suffix
Patient Account #
Subscriber Name
Claim Number
Claim Date Span
Provider of Service
Description
Subscriber’s number and patient suffix number (including alpha prefix)
assigned by Premera.
Patient number assigned by the provider/clinic/hospital. (If no account number
is assigned, the words “No Patient Account #” are noted.)
Subscriber’s name.
Claim number associated with the overpayment.
Date span of the claim. (The span will be the first through the last date of
service on the claim.)
Provider who rendered the service.
B Payment Reference ID This number specifies the current and/or prior payment vouchers applied
towards the overpayment. (Each SORA has its own payment reference ID
which is located in the upper right-hand corner.)
C Payment Cycle Date Date of payment shown in the system that relates to the Payment Reference ID.
D Prior Payment Cycle Original overpayment amount from prior statements (prints until balance is
zero).
E This Payment Cycle Overpayment amount that applied to this payment cycle.
F Payment From Provider Amount(s) the provider voluntarily paid toward the overpayment balance.
G Prior Payment Cycle Amount recovered from prior payment cycles.
H This Payment Cycle Amount recovered from current payment cycle.
I
Outstanding Over-
Payment
Balance of overpayments not recovered.
J Overpayment Totals Total amount for each column in the statement.
K
Total Recovered This
Payment Cycle
Total overpayments recovered in the current payment cycle.
Claims and Payment Chapter 7 Page 12