You use the Check Replacement page to reissue a check that is damaged, lost, stolen, or disputed. It can be a manual or systematic replacement. You can also use this page to reissue payments for failed electronic fund transfers (EFT).
You can edit the payment reissue information until the payment has been approved through the payout approval process.
The Check Replacement page contains the following panels:
| Field | Description |
|---|---|
| These fields are view-only. | |
| 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. |
| 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 |
| Member ID |
Unique identifier used for a member and is assigned when the member becomes eligible to receive Medicaid benefits. |
| Member Name |
The name of person associated with the member ID. |
| Field | Descriptions |
|---|---|
| FCN |
The financial control number (FCN) assigned to the receipt. The FCN consists of the date it was created, the media source (how it was received), and a document number. Format: YYYYMMDDMNNNNN |
| Financial Reason Code |
The code indicating why the transaction was added. |
| Original Check 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 |
| Original Check Number |
The warrant number that uniquely identifies a payment to a provider for a given payment cycle. Note: This field is only required for Manual Payouts. |
| 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. |
| Field | Description |
|---|---|
| FCN |
The financial control number (FCN) assigned to the replacement check. The FCN consists of the date it was created, the media source (how it was received), and a document number. Format: YYYYMMDDMNNNNN |
| Financial Reason Code |
The code indicating why the transaction was added. |
| Check Amount |
The amount of the replacement check to be issued. Note: The replacement check amount must be equal to the original check amount. |
| Check Number |
The warrant number that uniquely identifies a payment to a provider. Note: The check number is only required for manually issued check replacements. The number on the replacement check cannot be the same as the number on the original check. Leave blank when ND MMIS is issuing the check. |
| Check Date |
The date that appears on the warrant. Note: The check date is required only for manually issued check replacements. Leave this field blank when ND MMIS is issuing the check. |
| Related FT FCN |
The transaction control number of the financial claim created for this replacement check. |
Version as of 5/16/14.
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