Provider repayment history screen

This screen allows you to record payment adjustment details. When you record an adjustment, the system generates a reversal of the original payment request and creates a corrected payment request, or "replacement."

The system generates most payment adjustments automatically, when rate and service authorization changes are made during a claim period. Adjustments automatically generate payment request records and can be viewed during payment processing. A manual adjustment is necessary for situations that the system does not handle automatically, for example, when you discover that a provider was overpaid for a child's care.

How do I...

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.
Service	Select the service that was provided. This field is required.
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, unless this is a placement service.
Description	Enter a description of the service provided. You can enter up to 400 characters.
Basic Cost	Enter the cost of the service if there is no standard or contracted cost already established in the system for this service.