Difference: MedicaidPaymentReconciliationManual (15 vs. 16)
Revision 162010-04-08 - JeffPrentice
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Appx Medicaid Payment ReconciliationOverview | ||||||||
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The data on the Per Diem file is a combination of the actual data from the import file (Provider Number, Inpatient Rate, and Provider Name) and data the MPR system has added (Data Period and 35% of Inpatient Rate). The 35% rate is calculated during importing and is not present in the download file from the State. The amount on the bill is compared to 35% of the inpatient rate.
Activating Per Diem Editing | ||||||||
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| < < | After you have completed importing the Per Diem data for the appropriate range of dates the Medicaid Reconciliation system needs to be instructed to start editing incoming hospital/HMO records while creating the exception list. This is accomplished on the Parameter File Maintence screen. There are two fields which control if Per Diem is edited on the incoming bill, Validate Hosp Per Diem and/or Validate HMO Per Diem. You can set either or both. If neither is checked then incoming billing records will not be checked for Per Diem violations. | |||||||
| > > | After you have completed importing the Per Diem data for the appropriate range of dates the Medicaid Reconciliation system needs to be instructed to start editing incoming hospital/HMO records while creating the exception list. This is accomplished on the Parameter File Maintence screen. There are two fields which control if Per Diem is edited on the incoming bill, Validate Hosp Per Diem and Validate HMO Per Diem. You can set either or both. If neither is checked then incoming billing records will not be edited for Per Diem violations. | |||||||
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| < < | If Per Diem is activated and the calculated Per Diem on the bill is not equal to the stored Per Diem value the billing record will be listed on the exception report. You can have the system not list billing records as exceptions when the calculated Per Diem is less than the set Per Diem rate. Check Allow Amounts Less Than Per Diem to apply this edit. | |||||||
| > > | If Per Diem is activated and the calculated Per Diem on the bill is not equal to the established Per Diem value, the billing record will be listed on the exception report. You can have the system not list billing records as exceptions when the calculated Per Diem is less than the set Per Diem rate. Check Allow Amounts Less Than Per Diem to apply this edit. | |||||||
| The following example shows the new flags on the Parameter File Maintence screen. For illustration purposes the flags are all set to Yes (checked means yes). Initially theses flags will be set to No (blank, not checked). | ||||||||
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