Provider payment plan details

This screen allows you to record a payment action (returned check, repayment, lost warrant, and so on) associated with this adjustment record.

5101:2-47-23.1 Title IV-E agency contracting and contract monitoring

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

[FM09 s05]

Action	Selection action. This field is required.
Warrant/Check #	Enter the number of warrant or check that was issued. You can enter up to 10 characters.
Action Date	Enter the date of the action. Use the format MM/DD/YYYY.
Warrant/Check Date	Enter the date on the warrant or check. Use the format MM/DD/YYYY.
Action Amount	Enter the amount of the action. This field is required.