howto: Prepare Reimbursement Reports


"Print Reimbursement Reports"
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DC2200-1 Monthly Day Care Reimbursement Reports 6/10/96
SELECT 8:06:50


Payment Year........ ____
Payment Month....... __
State Provider...... ______ (SI only)
State Facility...... ________ (SI only)

Place_an_"X"_next_to_the_desired_function(s):
Create New Transactions... _
Print Turnaround Report... _
Print Service Invoices.... _

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Output Queue: PRT04_____ # of Copies: __1_ Hold?: N Save?: N

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F2 = Chg Print Defaults F3 = End
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Counties request reimbursement for payments made to Day Care Vendors using three methods -- Turnaround Report, Service Invoices, and the 1571. The 1571 is not supported in the Day Care module.


The Turnaround Report

The "Turnaround Report" is the primary mechanism for claiming reimbursement from the state of payments made to Vendors and for initiating direct payment to clients. The system prepares the report every month based upon the prior month's report and upon new Service Invoices. The county worker keys the data directly into the state system. 

This month's TR is last month's report less terminations, plus adds, plus changes.
 - County adds transactions via Service Invoice transaction effective in prior month.
 - SI transactions effective in months beyond prior month are not added to TR.
TR is starting point for requesting reimbursement in the current month.
 - County can permanently terminate a transaction by changing the Status Code.
 - County marks changes in red ink and returns report to the state.
 - Unchanged transactions plus changes become request for current month.
Accessing transactions via Sequence Number, state data entry people key changes.
There are multiple transactions for each Attendance Month for given Vendor.
 - Each SU generates separate transaction - ie, unique Payment Code.

The report is a set of monthly reports of all claim transactions for each unique Provider (Vendor) and Facility (Site). There is one detail line per Payment Code per Rate Group per Fund Source per Client.
 - For a given client there can be multiple detail lines per Provider/Facility report.
 - A client may appear on the report of multiple Provider/Facilities.
 - It can handle a retroactive claim or a claim with a new Payment Code.

Generating the Turnaround Report automatically
Data entry people like for changes from prior month to be clearly marked.
 - ONECase marks differences on the TR print output.
Transactions added to TR in prior month will generate a Sequence Number.
 - ONECase will not know Sequence Number of transactions added.
 - County must key Sequence Number of new transactions B4 printing final TR.

Age and Rate Group Rules
There are subtle differences between the rules for determining age of 5-year old children used by 
"Calculate Vendor Payment" and "Print Turnaround Report". 

R-Code Rules for arrangements registered by the state
On applications approved/registered by the state, they specify the R-Code series to be used. There is a flag in the Vendor record indicating whether the state has approved the application or not. If the flag is 'Y' use the R01 series; if 'N' use the R10 series. The table describes the rules.

State Approved Flag = 'Y'
(1) R03 5th birthday <=10/15 Service Unit = 'S' (School Age).
(2) R02 5th birthday >10/15

State Approved Flag = 'N'
(A) R15 Vendor is Individual 
(B) R03 5th birthday <=10/15 Service Unit NE 'S'. Vendor is Center 
(C) R06 5th birthday <=10/15 Service Unit = 'S'. Vendor is Center 
(D) R15 5th birthday >10/15 Vendor is Center 

Child's 5th birthday is <= 10/15
(1) R03 Flag='Y' Service Unit = 'S'
(B) R03 Flag='N' Service Unit NE 'S'. Vendor is Center
(C) R06 Flag='N' Service Unit = 'S'. Vendor is Center

Child's 5th birthday is > 10/15
(2) R02 Flag='Y'
(A) R15 Flag='N' Vendor is Individual
(D) R15 Flag='N' Vendor is Center


Rate Group Code Rules for determining the first character
Determine the first character as follows:

R      1st shift     S      1st shift Special Needs Supplement
T       2nd shift    U      2nd shift Special Needs Supplement
V      3rd shift     W      3rd shift Special Needs Supplement


Column Headings
Sequence Number
6-digit number generated by state system.
Follows detail line from month to month.
Appears to be way data keyers access the detail line item on state system.
To go to electronic report submission state system must have/develop another access.
ONECase - no corresponding field, no way to receive or generate this number.

Client Last Name (2)
First 8 letters of client's last name.
ONECase DC - truncated Person Last Name.

Client First Name (3)
First 6 letters of client's first name.
ONECase DC - truncated Person First Name.

Client Middle Initial (4)
1-character middle initial.
ONECase DC - truncated Person Middle Name.

Client Date of Birth (25)
DOB of client in MMYY format.
ONECase DC - reformatted Person DOB.

Client DCS Number (5)
11-digit DCS number. 
The DCS number appears to be required for Fund Source '25' transactions.
ONECase DC - now keyed into DCAPX, but needs to be store in Case/Client (CSCLF).

Client EIS Individual ID (20)
10-character Individual ID from EIS.
Similar to the DCS Number, the Individual ID appears to be required for Fund Source '30' transactions.
ONECase DC - now keyed into DCAPX, but needs to be stored in Person (CSPER).

Client Status Code (6)
1-digit code indicating the status of the detail line.
Not really a 'Client' status but is more a status of the transaction.
See the 'Child Day Care Reimbursement Codes' attachment for list of valid codes.
ONECase DC - no corresponding field, probably add to DCATD and deduce from context.

NW CT (22)
NHC does not use this field now and does not know what it does.

Service Date (18)
4-character field indicating month (MMYY) for which the claim is made.
Now always the current month.
On an electronic version of report, not necessarily limited to current month.
ONECase DC - reformatted 'Reporting Month' now in DCATD.

Category Code (7)
3-digit code.
See the 'Child Day Care Reimbursement Codes' attachment for list of valid codes.
ONECase DC - 'Eligibility Category' now in DCAPX.

Payment Code (8)
3-digit code.
See the 'Child Day Care Reimbursement Codes' attachment for list of valid codes.
ONECase DC - 'Payment Code with/without Special Need' now in DCAPX.
Structure of Payment Code

1st character Based upon Special Needs Flag (D2SNFL in DCAPX)
8 If flag is 'N'
4 If flag is 'Y'

2nd character Based upon Eligibility Category (D2ECAT in DCAPX)
0 ‘SKE’ 1 'EMP' 2 'CPS'
3 'EDT' 4 'DEV' 5 'CWS'
6 'FCS' 7 ‘PST’

3rd character Based upon Service Unit in Fee Detail (DDVSU in DCFDT).
1 'F' 3 'P' 'S' 
2 'Q' 9 '1' '2'

RN CD (23)
NHC does not use this field now and does not know what it does.

Rate Group (9)
3-character code indicating Rate Group for FSA and non-FSA.
See the 'Child Day Care Reimbursement Codes' attachment for list of valid codes.
ONECase - no field directly corresponding, should probably add to Voucher Work File.

Fund Source (10)
2-digit code indicating source of funding.
See the 'Child Day Care Reimbursement Codes' attachment for list of valid codes.
'25' if State Subsidy, '30' if AFDC or JOBS.
ONECase - now keyed into DCAPX, should drive from program and maybe store in DCATD.

ENH CDE (24)
NHC does not use this field now and does not know what it does.

Payment Rate (11)
Monthly, daily, or one-time rate driving Gross Charges.
ONECase - now pulled from Rate table, not stored.

Service Days (12)
Number of days paid at daily rate.
Should be able to multiply Service Days times Payment Rate to yield Gross Charges.
ONECase - not stored by Payment Code now, stored in total for the month.

Gross Charges (13)
Total payment before netting parent Co-payment.
ONECase - not stored by Payment Code now, stored in total for the month.

Imposed Fees (14)
Amount of parent Co-payment netted against Gross Charges.
ONECase - not stored now, calculated by voucher program.

Net Charges (17)
Gross Charges less Imposed Fees
ONECase - not stored by Payment Code now, stored in total for the month.

Service Invoices 

Service Invoices are another method of requesting reimbursement of DC payments.
 - Reversals of prior month transactions.
 - Correcting transactions for prior month reversal.
 - Additions to Turnaround Report for next month.
SI transaction contains same data as TR transaction.
 - Plus AFDC Case Number, County Case Number, and child's DOB.
SI effective for current reporting month generates transaction on next month's TR.
 - State system will assign a Sequence Number to these SI transactions.
 - Sequence Number appears on next month's TR.



How are corrections/adjustments processed? 

Adjustment is reversal of previous transaction and addition of correct transaction.
 - It is not a net transaction.
 - Currently, county uses Service Invoice to reverse a transaction in prior month.
 - Then adds correct transaction.
 - Depending upon Status Code, transaction may/may not appear on next TR.
Some adjustments involve multiple reversals/correcting transactions.
 - EG, incorrect DOB generates reversals for each month and Rate Code affected.
 - Also requires correcting transactions for each month and Rate Code. 
 - Correcting entry in current month can be handled via changing TR transaction.

Making changes to the TR in the current month.
TR deals only with transactions effective for current month.
Cannot add a transaction (Sequence#) directly to TR.
Can change any transaction (Sequence#) already listed on TR.
Add transaction to TR for next month using Service Invoice in current month.