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Print Clear REMITTANCE ADVICE STD. 404C (REV. 495) STATE OF CALIFORNIA THE ENCLOSED WARRANT IS IN PAYMENT OF THE INVOICES SHOWN BELOW DEPARTMENT NAME ORG. CODE INVOICE DATE INVOICE NUMBER INVOICE.

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Remittance information refers to the details provided about a payment, such as the invoice number, payment amount, and any discounts or deductions applied. It is included in a remittance advice document and helps the recipient apply the payment to the correct account and reconcile their records.

6 things to include in a remittance advice document Your company's name and address. Include this information to ensure the payment recipient can clearly identify who the payment is coming from. ... Recipient's name and address. ... Invoice number. ... Payment amount. ... Payment method. ... Issued date.

Remittance advice typically lists all the invoices being covered with a payment, along with the invoice numbers, dates, and other relevant information such as purchase order numbers. In the above example, the customer has also noted the discounts they have taken.

The Remittance Advice (RA) contains information about your claim payments that Medicare Administrative Contractors (MACs) send, along with the payments, to providers, physicians, and suppliers. The RA, which may either be in the form of an Electronic Remittance Advice (ERA) or a Standard Paper.

Purpose of Remittance Advice The purpose of the RA is to assist the vendor in identifying payment against their outstanding receivables which are pending payment. The RA prevents the vendor from needlessly contacting the agency/department to identify payment.

In short, remittance advice is a proof of payment document sent by a customer to a business. Generally, it's used when a customer wants to let a business know when an invoice has been paid.

STD 213 - Standard Agreement Link opens a document. Agreement between State Agency and Contractor.

Electronic Remit Advice (ERA) and Standard Paper Remit (SPR)

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232