Difference: MedicaidPaymentReconciliationManual (7 vs. 8)

Revision 82010-03-18 - JeffPrentice

Line: 1 to 1
 

Appx Medicaid Reconciliation

Overview

Line: 153 to 153
  http://www.fdhc.state.fl.us/Medicaid/cost_reim/hospital_rates.shtml
Changed:
<
<
+++per diem 1.jpg+++
>
>
per_diem_1.jpg
  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
Changed:
<
<
After The file you downloaded from the internet and saved in the /Download directory needs to be imported into the Medicaid Reconciliation system. The import process reads each record in the downloaded file and saves the information to a file in the Appx Medicaid system. Click the Import State Per Diem File. The following screen pops up.
>
>
The file you downloaded from the internet and saved in the /Download directory needs to be imported into the Medicaid Reconciliation system. The import process reads each record in the downloaded file and saves the information to a file in the Appx Medicaid system. Click the Import State Per Diem File. The following screen pops up.
 
Changed:
<
<
+++per diem 2.jpg+++
>
>
per_diem_2.jpg
  There are two fields that must be entered. The first field is the name of the file you downloaded and saved (MMMYYx format) in the /Download folder. The second field is for the semester, enter either 01 or 07 and the year. See next section for details.

If the name of the file to import cannot be found in the /Download directory a message similar to the following will be displayed. Note: the file name was changed from JAN06H to JAN07H in order to produce the error shown below.

Changed:
<
<
+++per diem 3.jpg+++
>
>
per_diem_3.jpg
 
Changed:
<
<
Since the incoming data covers a six month period beginning in either January or July, the date entered for the period is the beginning month for the period. Consequentially the date entered can only be 01/ccyy or 07/ccyy (where ccyy is the century and year). If the period date entered is invalid you will see an error message in the Status line of your Appx window.
>
>
Since the incoming data covers a six month period beginning in either January (01) or July (07), the date entered for the period is the beginning month for the period. Consequentially the date entered can only be 01/ccyy or 07/ccyy (where ccyy is the century and year). If the period date entered is invalid you will see an error message in the Status line of your Appx window.
 
Changed:
<
<
+++per diem 4.jpg+++
>
>
per_diem_4.jpg
  When the file is successfully imported into the Medicaid Reconciliation system, the following message will be displayed.
Changed:
<
<
+++per diem 5.jpg+++
>
>
per_diem_5.jpg
  The message will tell how many records were imported and reminds you to set the Validate Per Diem box(s), either Hospital and/or HMO to Yes (checked) on the Parameter File Maintenance screen. See Using Results below for instructions on setting these fields on the Parameter screen.

You may import the same period again if the State has sent a new or corrected file. Simply follow the same instructions except when the system detects the same period on file a warning message will be displayed, see following example. If you click the Continue button, the system will replace the existing data with the new file.

Changed:
<
<
To delete a per diem semester (period) see Delete a Per Diem Data Period.
>
>
per_diem_6.jpg

To delete a per diem semester (period) see Delete a Per Diem Data Period on the Special Functions Menu

 
Deleted:
<
<
+++per diem 6.jpg+++
 
Verify Per Diem File (Future Release)

This process will use the current date and check for all the semesters that should be in the per diem file.

Per Diem Inquiry

If you wish to view the per diem information that has been calculated and is currently residing in your system you can click this button then specify the semester you wish to look at.

Added:
>
>
per_diem_12.jpg
 
Per Diem List

This function will list the per diem data that is stored in your system. Enter the Data Period you wish to print and click Create List. Leave the Data Period blank to get a listing of the entire Per Diem file. After clicking Create List, the standard Appx Print Disposition screen will appear. Enter any specific instructions for the printed output and continue.

Added:
>
>
per_diem_13.jpg
 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 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
Line: 204 to 209
  The following example shows the new flags on the Parameter 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).
Deleted:
<
<
+++ per diem 10.jpg+++
 

Reporting

The reports available on this menu are for listing data from the current reconciliation cycle.

Line: 360 to 364
  This section of the menu has four buttons, Review All Exceptions, Nursing Home Only, Hospital Only, and HMO Only.
Changed:
<
<
+++ reconciling 1.jpg+++
>
>
reconciling_1.jpg
  These four functions display the corresponding exceptions list. Note the exception list category is displayed in the window title bar. The list shows basic information for each client and the reason(s) this record is on the exception list. Three records at a time are displayed on the exception list and as you go from record to record the list will cycle through all the records. The current record is circled with a blue line.
Changed:
<
<
+++ reconciling 2.jpg+++
>
>
reconciling_2.jpg
  As mentioned earlier, the default Payment Code (NR Code) is P00. P00 is the code that says you are going to pay your county’s share of this claim. The NR Code may also be automatically set by the MPR system depending on the No COR NP Code setting on the Parameter File Maintenance screen. This No COR NP Code is typically set to U05, No COR on File. You can still change this Payment Code if you wish.

To change a payment code and/or to see the complete detail for the current record click the Edit Non Pay Code button near the bottom of the screen. The follow screen will appear;

Changed:
<
<
+++ reconciling 3.jpg+++
>
>
reconciling_3.jpg
  From the detail screen you can review the data to and change the Payment Code if needed. Click the Save Changes to save the altered Payment Code. You will return to the Exception List screen and will be on the next record. Determining whether a client is eligible or not, is completely under your control.
Line: 384 to 388
  When you exit Appx and return at a later time the exception list will return to listing records in last name order starting at the beginning of the file. If you are in the middle of reconciling a bill and need to exit the system, you can ‘tag’ the current record. When you return to reconciliation at a later time, you can ‘jump’ directly to this tagged record.
Changed:
<
<
+++reconciling 4.jpg+++
>
>
reconciling_4.jpg
  To ‘tag’ a record location on the exception list, press the Save Location and Exit button instead of clicking the Exit button. The system will remember the current record. When you return to the exception list and wish to ‘jump’ to where you left off, click Go to Saved Location. Note: the Go to Saved Location button will only be displayed if you have previously exited by clicking Save Location and Exit. The system will remember this tagged record until you tag another or start a new bill. You can tag one record per billing category, all, nursing home, hospital, or HMO.
Line: 404 to 408
 The download and upload steps are performed using your internet browser, not the Appx system. Downloading and Uploading as well as Internet access may be restricted depending on your county’s policy.

After posting the MPR system resets itself in preparation for the next cycle.

Changed:
<
<

Special Functions Menu

The Special Functions menu contains processes to assist you in maintaining your system or to perform batch data processing.

start_appx_and_mpr_6.jpg

Rebuild History

This function will rebuild the history file from the reconciled billing files in the Upload directory.

Delete A Posted Medicaid Invoice

If you imported the wrong billing file (invoice) by mistake, you can delete the batch with this function and start over.

Change A Medicaid Number In The History File

If a client has their Medicaid ID number changed, this process will update the history file with the new ID number. Normally the history file is not modifiable.

Deny Payments By Billing Code

This is a handy tool that will let you deny an entire group of billing records. For example, if you wish to deny all HMO records in the current cycle, you can use this function to select HMO records and then identify the denial code you wish to put on these records. This only affects the currently imported batch.

Delete Posting With No History

Use this to remove batches that were started and never posted.

Delete a Per Diem Data Period

Use this function to delete a per diem semester.

+++start appx and mpr 6.jpg+++

From the Special Functions menu, click on Delete a Per Diem Data Period. The following screen will be displayed.

+++per diem 7.jpg+++

Enter the two digit month (MM) and the four digits century and year (CCYY) and click the Delete button. The month entered must be 01 or 07. If you enter a data period that does not exist on the Per Diem file an error message will be displayed. You must click the Delete button to execute this function. Pressing ENTER or the Exit button will not delete the records. If the delete is successful you will see a message indicating how many records were deleted, see example. You can only delete one period at a time.

+++ per diem 8.jpg+++

If no records were deleted, the following message will be displayed. You will see this message if you click the Exit button or pressed the ENTER key on the application screen.

+++ per diem 9.jpg+++

Rebuild Upload From History

Using the history file in the MPR system this process can rebuild the file(s) in the Upload directory.

Build New Exception List

If you import a bill and then realize that the COR file needs to be updated to reduce the number of exceptions you can invoke this special process. Please note any changes to this batch will be lost if you invoke this process. One handy way of using this function is to import a bill, go thru it and create COR’s for all the relevant records. Then invoke this process and the system will use the new records in the COR to reduce the number exceptions .

The Exit button will take you back to the MPR main menu.

How to upload the reconciled bill
>
>

How to upload the reconciled bill

  After the summary letter gets approved for payment you need to send the reconciled bill back to the State. The reconciled bill has been created by the Appx system and is residing in the Upload directory under the Appx folder on your server. The file name will be the same name you gave the bill when you Downloaded it, for example; OCT08P.txt. As you would expect, the upload process is similar to the download process. You are just selecting the file from the Upload directory rather than the Download. If you upload the file in the Download directory then what ACHA receives is the same data you downloaded. Nothing will be changed. If you get a call to that effect, chances are you’ve made this mistake. All that you need to do is upload the file from the proper directory, you do not need to reconcile again.
Line: 556 to 515
  The service date specified is after the “Moved Out” date on the COR for this client.
Deleted:
<
<
  • how_to_download_img_2.jpg:

  • how_to_download_img_11.jpg:

  • per_diem_1.jpg:
    per_diem_1.jpg

  • per_diem_2.jpg:
    per_diem_2.jpg

  • per_diem_3.jpg:
    per_diem_3.jpg

  • per_diem_4.jpg:
    per_diem_4.jpg

  • per_diem_5.jpg:
    per_diem_5.jpg

  • per_diem_6.jpg:
    per_diem_6.jpg

  • per_diem_7.jpg:
    per_diem_7.jpg

  • per_diem_8.jpg:
    per_diem_8.jpg

  • per_diem_9.jpg:
    per_diem_9.jpg

  • per_diem_10.jpg:
    per_diem_10.jpg

  • per_diem_11.jpg:
    per_diem_11.jpg

  • per_diem_12.jpg:
    per_diem_12.jpg

  • per_diem_13.jpg:
    per_diem_13.jpg

  • reconciling_1.jpg:
    reconciling_1.jpg
 
META FILEATTACHMENT attachment="client_1.jpg" attr="h" comment="Appx DeskTop Client Log In Screen" date="1268771890" name="client_1.jpg" path="client 1.jpg" size="12858" stream="client 1.jpg" tmpFilename="/tmp/6uCdnRc1EY" user="JeffPrentice" version="1"
META FILEATTACHMENT attachment="cor_entry_screen_1.jpg" attr="h" comment="" date="1268772158" name="cor_entry_screen_1.jpg" path="cor entry screen 1.jpg" size="78977" stream="cor entry screen 1.jpg" tmpFilename="/tmp/fBTsUJkfDR" user="JeffPrentice" version="1"
META FILEATTACHMENT attachment="how_to_download_img_1.jpg" attr="h" comment="" date="1268772185" name="how_to_download_img_1.jpg" path="how to download img 1.jpg" size="59514" stream="how to download img 1.jpg" tmpFilename="/tmp/F3pO8OTV7J" user="JeffPrentice" version="1"
Line: 638 to 551
 
META FILEATTACHMENT attachment="per_diem_12.jpg" attr="h" comment="" date="1268937262" name="per_diem_12.jpg" path="per diem 12.jpg" size="42976" stream="per diem 12.jpg" tmpFilename="/tmp/Mf1bb3OsF4" user="JeffPrentice" version="1"
META FILEATTACHMENT attachment="per_diem_13.jpg" attr="h" comment="" date="1268937279" name="per_diem_13.jpg" path="per diem 13.jpg" size="16315" stream="per diem 13.jpg" tmpFilename="/tmp/qxQTC3nVdD" user="JeffPrentice" version="1"
META FILEATTACHMENT attachment="reconciling_1.jpg" attr="h" comment="" date="1268937300" name="reconciling_1.jpg" path="reconciling 1.jpg" size="90594" stream="reconciling 1.jpg" tmpFilename="/tmp/3Vs9o3nRIr" user="JeffPrentice" version="1"
Added:
>
>
META FILEATTACHMENT attachment="reconciling_2.jpg" attr="h" comment="" date="1268945566" name="reconciling_2.jpg" path="reconciling 2.jpg" size="73795" stream="reconciling 2.jpg" tmpFilename="/tmp/o0FnQKNYM2" user="JeffPrentice" version="1"
META FILEATTACHMENT attachment="reconciling_3.jpg" attr="h" comment="" date="1268945585" name="reconciling_3.jpg" path="reconciling 3.jpg" size="70066" stream="reconciling 3.jpg" tmpFilename="/tmp/bTOt6Mqzjc" user="JeffPrentice" version="1"
META FILEATTACHMENT attachment="reconciling_4.jpg" attr="h" comment="" date="1268945599" name="reconciling_4.jpg" path="reconciling 4.jpg" size="7359" stream="reconciling 4.jpg" tmpFilename="/tmp/K6dCCD2AoF" user="JeffPrentice" version="1"
 
This site is powered by the TWiki collaboration platform Powered by PerlCopyright © 2008-2024 by the contributing authors. All material on this collaboration platform is the property of the contributing authors.
Ideas, requests, problems regarding TWiki? Send feedback