The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

The type of financial entity that can make payments and/or receive payments.

Examples: Provider, Member, Carrier

The code associated with the type of payee/payer.

Defaults: If the Payee/Payer Type is Provider, then the Payee/Payer ID Type Code is Medicaid. If the Payee/Payer Type is Member, then the Payee/Payer ID Type Code is Medicaid ID. If the Payee/Payer Type is Carrier, then the Payee/Payer ID Type is Carrier ID.

Unique identifier of the payee/payer.

The name of the payee/payer. Dependent upon the Payee/Payer Type Code and Payee/Payer ID on file in ND MMIS.

Unique identifier in ND MMIS that represents the payee/payer ID.

Unique code representing a logical grouping for financial reason codes.

Examples: Gross Level Receivable, Withholding/Lien/Levy, Advanced Payment, Claim Receivable

The financial control number (FCN) assigned to the financial document. The FCN consists of the date it was created, the media source (how it was received), and a document number.

Format: YYYYMMDDMNNNNN

Links to appropriate Accounts Receivable page for the receivable.

The date that the original account receivable was created.

The amount of the original account receivable.

Format: Displayed as currency with $ symbol left of the value and two digits to the right of the decimal.

Display Example: $9999999.99

The transaction control number (TCN) of the claim's financial transaction (FT) that is created during claims processing to reflect the receivable.

Links to the Claims Inquiry page for the claim associated with the control number, if you have access.

The current balance amount of the account receivable transaction.

The account receivable letter aging status.

Sum of the revised account receivable amount, revised interest, revised penalty, and revised fees.

The type of Alternate ID being used as the Member ID.

Examples: Medicaid, SPED, Voc Rehab

The amount of interest accruals on the account receivable. An interest charge is imposed on the remaining balance when the account receivable is not exempted from interest charges.

The Member ID of the member on whose behalf this financial action was created.

The amount of penalty accrued on the account receivable. A penalty charge is imposed when payment has not been received on time. This occurs when the account receivable is not exempt from penalties.

The name of person associated with the member ID.

The new revised A/R Amount if different from the original A/R amount.

Default: Original A/R Amount

The code indicating why the adjustment was entered.

Note: Required if revised A/R amount differs from the original A/R amount.

The revised interest amount.

The interest charge to be imposed on the remaining balance when the account receivable is not exempted from interest charges.

The revised penalty amount.

The penalty charge to be imposed when payment has not been received on time. This occurs when the account receivable is not exempt from penalties.

The revised fee amount.

The fee charge to be imposed for handling of the accounts receivable. This occurs when the account receivable is not exempt from being charged fees.

Adjusted A/R amount is the sum of the revised A/R amount, revised interest, revised penalty and revised fee.

The Adjusted A/R Amount is calculated when you click Calculate.

The financial control number (FCN) assigned to the account receivable adjustment. The FCN consists of the date it was created, the media source (how it was received), and a document number.

Format: YYYYMMDDMNNNNN

The revised interest amount entered into the adjustment.

The code indicating why the adjustment was entered.

The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

The revised penalty amount entered into the adjustment.

The date that the original account receivable adjustment was created.

The revised fees amount entered into the adjustment.

The transaction control number of the financial claim created for this adjustment.

Links to the Claims Inquiry page for the claim associated with the control number, if you have access.

Sum of the revised account receivable amount, revised interest, revised penalty, and revised fees.

The amount of the original account receivable.

Format: Displayed as currency with $ symbol left of the value and two digits to the right of the decimal.

Display Example: $9999999.99

Sum of the adjusted account receivable amount, adjusted interest, adjusted penalty and adjusted fees.