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:
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. |
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. |
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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