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Death Penalty

por vanessa balzer

Chapter2 Transaction Processing in the AIS

por SISI YANG

Stan Lee

por Aidan Harmes

LIDERAZGO EN ENFERMERIA

por GIANELLA ALEXANDRA CALLE MONZON

Recoupment

Originally file from State was focused on recoupments? 820 file Code "03"

Codes in payment file? Dana

Tina : Can we get other codes?

4.) IMD (Inst Med Disease) recoupment

Claims

State will take back initial revenue capitation (gradiated by age/gender) payment

Sometimes BH pays > 15 day w/HCI money

Send them How many days a member has > 15 day stay

3.) Date of Death recoupment

Example: John Doe passes away what happened to the payment during the month he passed away. This should not be taken if it was never given.

Cathy would dl the dod file , send to CO IT and analyze

No longer from HMS

Is the member the State taking money back on actually shows a service?

DOD taking $ , Claims and Encounters

Did we get a payment?

HMS auditing contract w/State

2.) Correct payment

New benefit for SUD Jan

Similar to rate change, started 1/1/2021

Files:

Similar to rate change Elig member

Rev increased from 50pmpm to 52pmpm (as an example)

WE have to ensure that the $52 pmpm came in for each member

No code in file?

What is the code that shows the payment increase?

Whats the code for the payment?

1.) Rate Change

Files needed:

Alyssa sends a report to State

Cap files

HCI send us the rate (Ken also has)

Prior fiscal year payment held for July and Aug but then all those rates (July and August)

July/Augst 2 month contract delay