This screen allows you to define the agency and provider on the Provider Repayment Plan and display the report in a print-ready format.
Record an agency repayment plan
View or print a form, notice, or letter
View or print a standard report
Agency
Select the agency for which the repayment plan was created. This field is required.
Provider
Enter the ID number of the provider who incurred the overpayment.
[RPT 240]