You use the Receipt page to add or edit receipts.
The Receipt page contains the following panels:
| Field | Description |
|---|---|
| Void |
When editing, indicates whether the record is active (No) or inactive (Yes). If inactive, the record is ignored when processing. If the record has been voided, none of the information can be changed. |
| LOB |
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. |
|
When adding, to verify that the ID exists in ND MMIS, click Validate. If it does, then the payee/payer's name and system ID are displayed. If the payee/payer has an existing account receivable, the information is displayed in the Disposition panel. |
|
| Payee/Payer Name |
The name of the payee/payer. Dependent upon the Payee/Payer Type Code and Payee/Payer ID on file in ND MMIS. |
| System Payee/Payer ID |
Unique identifier in ND MMIS that represents the payee/payer ID. |
| Member ID Type |
The type of Alternate ID being used as the Member ID. Examples: Medicaid, SPED, Voc Rehab Note: Required when the reason code is for Payout of HIPP. |
| Member ID |
Unique identifier used for a member and is assigned when the member becomes eligible to receive Medicaid benefits. |
|
When adding, to verify that the ID exists in ND MMIS, click Validate. If it does, then the member's name is displayed. |
|
| Member Name |
The name of person associated with the member ID. Automatically displayed if validated. |
| Field | Description |
|---|---|
| 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 |
| Activity Type Code |
Unique code representing a logical grouping for financial reason codes. |
| Financial Reason Code |
The code indicating why the transaction was added. |
| Established Date |
The date that the receipt was created. |
| Deposit Date |
The date that the deposit was received. |
| Original Amt |
The original amount of the receipt. Format: Displayed as currency with $ symbol left of the value and two digits to the right of the decimal. Input can be up to seven digits before the decimal and two digits after the decimal. Input Format: 9999999.99 Display Format: $9999999.99 |
| Balance Amt |
The current balance amount of the receipt transaction. Note: When adding a receipt the original amount and the balance amount are the same. |
| Related FT FCN |
The transaction control number of the financial claim that is created for this receipt. |
| Last Applied Date |
The last date that a payment was posted against the account receivable transaction. |
| Pending Reason |
Indicates why the transaction pended, if applicable. |
| Pend Date | The date that the pending reason was set. |
| Check Number | The number on the check that was received or the EFT trace number for a failed electronic fund transfer. |
| Internal Tracking Number |
Unique tracking number to identify the financial receipt transaction. Tip: If it is added or changed then a mass adjustment is scheduled to run. |
| Field | Description |
|---|---|
| If the payee/payer has an existing account receivable, these fields are displayed. To edit, in the Receivables Details table, click the appropriate row. | |
| Receivable FCN |
The financial control number (FCN) assigned to an account receivable. 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 disposition was entered for the receipt. |
| Financial Reason Code |
Indicates why the transaction was dispositioned against this receivable. |
| Original Amount or A/R Original Amount |
The original amount of the receipt. Format: Displayed as currency with $ symbol left of the value and two digits to the right of the decimal. Input can be up to seven digits before the decimal and two digits after the decimal. Input Format: 9999999.99 Display Format: $9999999.99 |
| Balance Amount or A/R Balance Amount | The balance of monies due to be received later. |
| Amount to Apply | The amount of monies applied towards the receivable. |
| Field | Description |
|---|---|
| To add refund information, click Add Refund Information. To edit, in the Disposition Details table, click the appropriate row. | |
| FCN |
The financial control number (FCN) assigned to the refund transaction. The FCN consists of the date it was created, the media source (how it was received), and a document number. Format: YYYYMMDDMNNNNN |
| Reason Code or Disposition Reason Code |
The code indicating why the receipt is being dispositioned. |
| Biennium Start |
The beginning year of the two-year State budget cycle that covers the date the financial action was done. Format: YYYY Default: Current biennium year for the State |
| Fund Code |
The budget and funding sources applicable to a claim. Displayed only when adding a new refund. |
| Category of Service |
The category of service associated with the refund. This affects the federal reporting. |
| Payment Amount | The amount of the payment to be refunded. |
|
Payee/Payer Type |
The type of financial entity that can make payments and/or receive payments. Examples: Provider, Member, Carrier Displayed only when adding a new refund. |
| Payee/Payer Type ID |
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. Displayed only when adding a new refund. |
| Payee/Payer ID |
Unique identifier of the payee/payer. Displayed only when adding a new refund. |
|
Overpayments Fields These fields provide information to help you to refund payments to a carrier when an overpayment has occurred. To display the Overpayments table, on the Refund Information action bar, click View Overpayments List. |
|
| Line Items | The line item number associated with the claim. |
| TCN | The transaction control number associated with the claim. |
| Overpayment Amount | The amount of the TPL overpayment associated with this claim line item. |
| Link To | Allows you to link the overpayment to the refund being issued. |
| Field | Description |
|---|---|
| Financial Reason Code |
The code indicating why the receipt is being dispositioned. |
| Fund Code |
The budget and funding sources that apply to the financial action. Note: Required if Disposition Reason Code field is completed. |
| COS | Category of Service. The services for which the account receivable is established. |
| Payment Amount | The amount of monies applied to other/billing receivables. |
| Field | Description |
|---|---|
|
History Fields When editing, this panel is view-only. |
|
| LOB |
The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid. |
| Financial Reason Code |
The code indicating why the transaction was added. |
| Established Date | The date that the receivable transaction was established. |
| Original Amount |
The original amount of the receipt. Format: Displayed as currency with $ symbol left of the value and two digits to the right of the decimal. Input can be up to seven digits before the decimal and two digits after the decimal. Input Format: 9999999.99 Display Format: $9999999.99 |
| Applied Amount | The amount of monies applied against the original amount. |
|
Balance Amount |
The amount of monies remaining to be received. |
|
History Table Fields Only applicable when editing. |
|
| FCN/TCN |
The financial control number (FCN) or the transaction control number (TCN) of a claim or receipt applied to the receivable. |
| Line Item Number |
The line number associated with the financial control number (FCN) or transaction control number (TCN). |
| Financial Reason Code | The reason code indicating why the disposition was done. |
| Disposition Date | The date that the disposition was entered. |
| Applied Amount | The amount of the disposition applied to the receipt. |
| Overpayment Amount |
The amount of the overpayment received for the FCN/TCN. |
Version as of 5/16/14.
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