SLIDE 2 Objectives
- Reimbursement Rates and how they’re determined
- October Building Data
- Filing Claims and error messages
- Deadlines and Exceptions
- Revisions – for claims and calendars
We are presenting this training module to provide sponsors with useful tools to help with questions and procedures they have for filing a successful claim.
- 1. Reimbursement Rates and how that is determined (severe bk rate, high/low meal
rate, state co pay, etc.)
- 2. Data gathering and report clean up before entering claim (to ensure accuracy)
Run month end data report to check for default entity, accuclaim reports, and building count data, physical counts to reported counts.
- 3. October building data and what to do when eligibility numbers have changed,
entering new enrollment data field
- 4. Filing claim and error messages (what do they mean) Ok to Pay, Partially paid, Error
Status etc.
- 5. Filing deadlines and pay exceptions (60 day rule) Crosstrain additional staff to know
how to file claim in the event you are not able to. Make a habit of filing claim by (lets say) the 10th of the following month. Put it on calendar as apt to set time aside to do that.
- 6. When revisions need to be made. Upward only within the 60 day period unless
requesting pay exception. Downward revisions always allowed. Explain process for pay exception. What is needed in the formal letter? Two points we look for, A corrective plan of action CAP, what steps have you taken to ensure late claiming will 2