Manual payment request screen

The system builds payment request rosters based on approved service authorizations and adjustments. This screen allows you to record a payment request that is not associated with a service authorization and add to a payment request roster.

You can record a manual payment request for any type of service, even one that should have a service authorization. If the system finds a payment for the same payee, recipient, and service, but without an authorization, the system will not generate another payment request for the same period. It updates the authorization number in the payment record and the units used in the service authorization.

The Calculate button instructs the system to recalculate the amount in the Total Amount field.

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Related policies

5101:2-47-15 Foster care maintenance program reimbursability: authorization for foster care maintenance and auxiliary payment reimbursements

Fields on this screen

Invoice Number	Enter the invoice number on the invoice, if any, the agency received from the provider.
Invoice Date	Enter the date the invoice, if any, was submitted.
Vendor Number	Enter the provider's vendor number, if any.
Override Payee	Select this check box if the payment should go to the payee/provider.
Service Category	Select the category of the service that was provided. This field is required. If a service authorization is linked to this record, the system disables this field and displays the category from the service authorization record.
Service Type	Select the type of service that was provided. This field is required. If a service authorization is linked to this record, the system disables this field and displays the service type from the service authorization record.
Service Description	Select the description for the service type selected. This field is required. If a service authorization is linked to this record, the system disables this field and displays the service description from the service authorization record.
Pre-Paid	Select this check box if the agency has already paid for the service. A "P" appears in the Total field for pre-paid services These payment request records appear on the roster to be balanced and approved but are not disbursed to the final roster for payment.
Service Start Date	Enter the date on which the service started. Use the format MM/DD/YYYY. This field is required.
Service End Date	Enter the date on which the service was completed. Use the format MM/DD/YYYY. This field is required.
Purchase Order	Enter the number on the agency's purchase order, if any.
Units	Enter the number of units of the service. This field is required.
Description	Enter a description of the service provided. You can enter up to 400 characters.
Basic Cost	Enter the manual payment amount. (If this is not a manual payment, this field is disabled.)