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Reversal Page

You use the Reversal page to reverse a receivable, provided the receivable has no payments applied to it.

The Reversal page contains the following panels:

 

Header Fields

Field Description
These fields are view-only.
Line of Business

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

Payee/Payer Type

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

Examples: Provider, Member, Carrier

Payee/Payer ID Type Code

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.

Payee/Payer ID

Unique identifier of the payee/payer.

System Payee/Payer ID

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

 

Original Request Fields

Field Description
These fields are view-only.
FCN

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.

Established Date

The date that the original account receivable was created.

Original A/R Amount

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

Related FT TCN

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.

Balance Amount

The current balance amount of the account receivable transaction.

A/R Letter Sent

The account receivable letter aging status.

Adjusted A/R Amount

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

Member ID Type

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

Examples: Medicaid, SPED, Voc Rehab

Interest

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.

Established on behalf of Member ID

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

Penalty

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.

Member Name

The name of person associated with the member ID.

Fees

The amount of fees accrued on the account receivable. A fee charge is imposed for handling of the accounts receivable. This occurs when the account receivable is not exempt from being charged fees.

 

Reversal Fields

Field Description
Only the Financial Reason Code field can be edited.
FCN

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

Format: YYYYMMDDMNNNNN

Established Date

The date that the reversal was created.

Original A/R Amount

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

Related FT TCN

The transaction control number of the financial claim created for the reversal.

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

A/R Letter Sent

The account receivable letter aging status.

Financial Reason Code

The code indicating why the transaction was added.

Adjusted A/R Amount

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

Balance

The current balance amount of the account receivable transaction.

Interest

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.

Penalty

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.

Fees

The amount of fees accrued on the account receivable. A fee charge is imposed for handling of the accounts receivable. This occurs when the account receivable is not exempt from being charged fees.

 

Version as of 5/16/14.

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