Difference: MedicaidPaymentReconciliationManual (3 vs. 4)

Revision 42010-03-16 - JeffPrentice

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	Appx Medicaid Reconciliation Overview
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	System Settings. Fiscal Year Start Month can be set to your fiscal period starting month. There are a few reports that can be sorted by fiscal year. No COR NP Code, identifies the default denial code the MPR system puts on incoming billing records that do not have a COR record on file. Import Eligibility Code is the default eligibility code you wish to have placed on imported COR records. The Server OS Type is for identifying the operating system (OS) type. The MPR system needs this to determine the OS command structure syntax. Import/Export File Path is the complete OS path to your MPR system data directory. If the Appx system is moved to another location on the current server or move to a different location on another server this path must be changed. Add Payment History Records
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< <	This input process allows you to enter data into the history files.
> >	This input process allows you to enter data into the history files. Use this function to add billing history from bills that were not reconciled using the MPR system. MPR will automatically maintain a history for each batch processed.
	Reporting Functions Most reports comprise a multi-process step. Depending on the design of the report some of these steps may not exist. The first step is to obtain the constraints of the data. The second step will allow you to control sort order. Step three asks you for 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. List Medicaid Clients With No Activity
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< <	List’s clients with COR records that have no billing history. Use this report to clean-up your COR file by deleting un-billed clients.
> >	List’s clients with COR records that have no billing history. If you added a COR and there is no history something might be wrong with the COR record keys. Us this report to check for this condition and investigate the reason why no billing records have accessed this history information.
	Payment File Status Recap Print a summary list of the current batch you are reconciling. This report shows client information, payment code, and amounts either paid or denied.
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	List nursing home clients that also have hospital billing records in history. Client Count and Total Paid By Batch
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< <	List the count of clients assisted within a date range. Also totals the amount paid for the period defined.
> >	List the count of clients assisted within a date range. Also totals the amount paid or denied for the period defined.
	Other Menus The large button, Medicaid Payment Processing Menu, will invoke the reconciliation menu. The Special Functions Menu is for performing unique task. Medicaid Payment Reconciliation Menu Certificate of Residency
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< <	The Certificate Of Residency section is where you can maintain COR records and mark them as Eligible or not.
> >	The Certificate Of Residency section is where you maintain Certificate of Residency (COR) records. As each client record in the monthly bill is read by the MPR system, it is checked against the COR file. If a matching COR record is found and that COR record is flagged as Eligible (EL) then this billing record will not be listed as an exception. Instead the billing record will be passed and will not appear on the exception list.
	Notice updating or adding COR records is not part of the reconciliation process. You can, and should, maintain your COR file periodically throughout the month. Having a robust COR file will save you a lot of time each month reconciling the bill. Cert of Residency/Addr Verification Entry
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	Also from this screen you can invoke other process. Last Valid Address (Nursing Home) is where you can record the clients last known address prior to entering the nursing home. Address Verification (Hospital, HMO) for entering the hospital address. Client Contact Information for storing the clients’ legal representative and public assistance case worker. Medicaid Payments History shows prior activity for this client.
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< <	A COR record must be identified as being a nursing home COR and/or a Hospital COR. There are two check mark boxes in the Facility section of this screen for identifying the type of COR verification intended for this client. Nursing home COR are common and will be the predominate type of COR records in your COR file. Hospital COR’s are different. Because of the high dollar amount of hospital and HMO bills you may want to review each record individually each month. In that case you would not define a hospital COR, however, if you wish, you can create a hospital COR and mark it eligible. As with nursing home, hospital and HMO billing records matching and eligible COR will not be listed on the exception list. A COR can be both a nursing home and hospital COR.
> >	A COR record must be identified as being a nursing home COR and/or a Hospital COR. There are two check boxes in the Facility section of this screen for identifying the type of COR verification intended for this client. Nursing home COR are common and will be the predominate type of COR records in your COR file. Hospital COR’s are different. Because of the high dollar amount of hospital and HMO bills you may want to review each record individually each month. In that case you would not define a hospital COR, however, if you wish, you can create a hospital COR and mark it eligible. As with nursing home, hospital and HMO billing records matching and eligible COR will not be listed on the exception list. A COR can be both a nursing home and hospital COR.
	Import State COR File Use this function to import the electronic State COR file. Currently the State does not produce a importable COR file. Review New COR Information
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< <	This process lists all the newly imported COR records from the State. Each COR must be reviewed for eligibility. The COR file will be updated with the incoming record if the COR is accepted.
> >	This process lists all the newly imported COR records from the State. Each COR must be reviewed for eligibility. The COR file will be updated with the incoming record if the COR is accepted. This process is tied to the Import State COR File which is currently not being used.
	Hospital Per Diem The Hospital Per Diem section contains processes that allow you to import and inquire the State per diem rates.
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	+++per diem 1.jpg+++
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< <	Per Diem files are under the heading Hospital Rates on this web site. The file you download consist of all the providers within Florida. There are not specific files for each county as with the bill. The file will download as a spreadsheet (xls, Excel). Open this file with Excel and save it as a tab delimited text file to the /Download directory. Name the file using the standard MMMYYx format. For example, JAN05H. Use H to identify this file as a hospital per diem file.
> >	Per Diem files are under the heading Hospital Rates on this web site. The file you download includes all the providers within Florida. There are not specific files for each county as with the bill. The file will download as a spreadsheet (xls, Excel). Open this file with Excel and save it as a tab delimited text file to the /Download directory. Name the file using the standard MMMYYx format. For example, JAN05H. Use H to identify this file as a hospital per diem file.
	Important note: There are several years/semesters available for downloading. You will need to download files to cover the anticipated service dates for the billing records you are currently receiving from the State. Import State Per Diem File

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Difference: MedicaidPaymentReconciliationManual (3 vs. 4)

Revision 42010-03-16 - JeffPrentice

Appx Medicaid Reconciliation

Overview

Add Payment History Records

Reporting Functions

List Medicaid Clients With No Activity

Payment File Status Recap

Client Count and Total Paid By Batch

Other Menus

Medicaid Payment Reconciliation Menu

Certificate of Residency

Cert of Residency/Addr Verification Entry

Import State COR File

Review New COR Information

Hospital Per Diem

Import State Per Diem File