An issue was identified on the August 2025 Remittance Advice (RA), where Paediatric Age Premiums were not paid or reported for claims assessed in July 2025 with service dates on or after July 1, 2024. This may have resulted in incorrect recoveries and negative balances on the August RA for some providers.
Medical Claims Adjustment (MADJ)
A Medical Claims Adjustment (MADJ) has been performed to reprocess the impacted claims. Physicians can expect to see adjustments for Paediatric Age Premiums on the September 2025 RA.
Claims reprocessed with no change in payment will appear on the RA with explanatory codes 55 – This deduction is an adjustment on an earlier account and 57 – This payment is an adjustment on an earlier account. These two transactions will net to $0 with no payment impact other than correcting the paediatric age premium and will report on the RA for reconciliation purposes.
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