Difference: WebHome (37 vs. 38)

Revision 382010-09-10 - JeffPrentice

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Figure: Appx Main Menu

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From the Appx main menu you can start the MPR system, alter the Appx environment, or modify the MPR programs. There may be times you want to maintain or modify the system however someone from Appx will be helping you with that. To start the MPR system for reconciliation click on Run an Application and enter the three character “Database ID” for your county. Each county has a different Database ID. You can click on the binoculars and search the list to find the Database for the MPR system.

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Menus, Current Status Tab

Figure: Current Status Tab

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The illustration above shows the Current Status Menu. This is the starting point for the MPR system. The large Appx icon shown can be replaced with your counties logo. The status menu shows your current status in the reconciliation cycle, the last billing file you imported and the batch name created for that file.

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You can conveniently get to the online manuals. The Appx Users Guide

and the Medicaid Payment Reconciliation Manual (this manual) from the Status screen by clicking on the WWW icon or on the manual title itself.

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You can conveniently get to the online manuals. The Appx Users Guide

and the Medicaid Payment Reconciliation Guide (this document) from the Status screen by clicking on the WWW icon or on the manual title itself.

The Appx Users Guide

is a general guide for using any Appx application. Some of the Appx User Guide

is in a movie format that you can view <a target="_top" href="http://www.appx.com/assets/asp/dynamic_generator.asp?pageid=939">here</a>. As mentioned earlier, the MPR system runs in the Appx environment. You should review the Appx Users Guide

at some point to familiarize yourself with how the Appx interface functions.

How to Add a County Logo

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The illustration above shows the Administration Menu. The functions on this menu are used to access files and records that control how the monthly billing file is processed. Items on this menu are grouped into five categories. Setup Information is used for general reconciliation cycle control. Code Table Maintenance is used for specific codes referenced within the system. Client Residency Information is for entering and maintaining Residency record information on clients. Hospital Per Diem is used to maintain Per Diem rates.

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The exclamation point in the bubble to the right of the functions on this and other menus is a direct link to the associated topic in the Medicaid Reconciliation manual.

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The exclamation point in the bubble (info bubble,

) to the right of the functions on this and other menus is a direct link to the associated topic in the Medicaid Reconciliation Guide. A word of warning, each time you click a help bubble a new browser session may open. That can be a good thing and it can be a bad thing. Please be aware that it is happening.

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Each function is described in detail below.

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The Medicaid Reconciliation Guide is not intended to be printed nor is it a substitute for Appx phone support. If you are on annual support with Appx and are having problems please call 1-800-879-2779 for assistance.

Each function on this menu is described in detail below.

Parameter File Maintenance

Figure: Parameter File Maintenance Screen

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This input process is used to maintain your MPR system settings.

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Eligibility Code Maintenance

Figure: Eligibility Code Maintenance Screen

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Maintain the code(s) for designating the client’s eligibility. Eligibility is assigned on the Residency record maintenance screen. Defining Residency records and identifying eligibility is the cornerstone of the MPR system. You can have multiple codes for eligibility, check the Auto Except box if this eligibility code designates and exception record that must be reviewed.

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The illustration above shows the Reconciliation Menu.

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The illustration above shows the Reconciliation Menu before starting a reconciliation cycle. The functions on this menu will become active (teal) or inactive (gray) depending on the reconciliation step you are in.

Reconciliation Overview

The electronic bill is available to Florida Counties each month on the AHCA web site. You download the bill from the web site, save it on your computer, and using the Appx MPR system import the bill for processing. The bill contains six categories of data (billing types);

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The above illustrates the results of a search for 01/01/2008 (test data). Bills that are available for download are listed. The File Name, Description, the Document Type, Actual Date Available, and the Date this file was previously Downloaded, if applicable, is shown. Use this list to select the file you wish to download and click the “download” button in the lower right corner.

Do not download more than one file at a time.

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Do not download more than one file at a time.

Downloading creates a single file. Selecting multiple files for downloading creates a single file that will contain data from different months, not a good thing for reconciliation. You can download one file, save it locally then, while on this web page, download another and save it, presumably to another file name. Each monthly billing file represents a “batch” to the MPR system.

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Before you can begin a reconciliation cycle you must have downloaded a bill and saved it as a tab delimited text file on your desktop. Start the MPR system and click on the Reconciliation tab. The Reconciliation menu is displayed.

Figure :Reconciliation Tab

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At the beginning of a reconciliation cycle the menu should look as it does in the above example. The teal colored selections are active and the grayed selections are inactive. As you proceed through the various steps, these selections will become active or inactive to guide you through the entire process. Notice you can get to the AHCA web portal to download the file.

Move Billing File to Server

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Menu-Reporting Tab

Figure: Reporting Tab

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Most reports comprise a multi-process step. Depending on the design of the report some of these steps may be bypassed. The first step, if shown, is to obtain the constraints of the data. The second step, if shown, will allow you to control sort order. Step three lets you define print characteristics such as printer name, form name, etc. By default reports are displayed on your screen prior to physically printing the report on a printer.

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This report will combines batches from history and provides a paid/denied dollar total as well as the total number of Medicaid clients within selected period. History records can be filtered by billing type. This report is similar to Payment Analysis Per Client however this report sums multiple occurrances of the same client(s) within the date range (batches) selected. Also, the total payments include any adjustments.

When the report runs you will select the starting and ending batches. The report is inclusive of the ending batch. You will also select the type of billing record you wish to report on. You have the option to print a detailed report or a summary only. The detailed report will list all client records and can be a rather long listing. The summary sub-totals each billing type and provides an overall grand total for the entire period.

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Hospital/HMO Payment Report

This report will list and total the amount billed and the county share for each hospital or HMO record within a specifed range of dates (invoice dates). You are prompted for the beginning month/year and the ending month/year before the report runs. This report runs from data in the history file, therefore any batches that have not been posted will not appear on this report.

Residency File Listing

List the Residency record file.

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Resident record not set for NH

A Residency record exists for this nursing home client but the “Nursing Home Verification?” field is not checked. When this field is not checked the Residency recordexists but is inactive.

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Listed for review

The eligibility code on the Residency record for this this nursing home client requires this record to appear on the the exception list.

Default deny code used

The default deny code for this record was used to override the payment code. The default deny code is defined in the Eligibility Code table.

Address change

There is a difference in the address on the Residency record and the billing record. While viewing the Residency record you can quickly see the difference by clicking on the Show Address On Bill button.

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Resident hospital flag not set

For this Hospital or HMO client there is a Resident record on file but the “Hospital Verification” field is not checked. When this field is not checked the Resident record exists but is inactive.

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No residency record

There was no Resident record on file for this Hospital or HMO client.

County share is more than the bill amount

The specified County share for this record is greater than the specified bill amount. This exception can occur on all record types.

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