Based on the payment adjustment request, the provider may need to turn in information for review. The provider must supply verbally or in writing enough information for the request to be adequately reviewed. Different situations may require varying levels of documentation. Below is a list of possible items the provider should supply when making the request:
Identifying case number (authorization, CL ID, Application number) Case Name Child's Name (for each child they are requesting payment for) Requested months of underpayment Number of requested underpayment units (hours or days) for each month for each child Attendance Records The provider number and telephone number Closure days for each month Any professional days billed
Some requests may need less information than listed above and some requests may need more. Review the request and determine the minimum needed from the provider. Factors to consider are:
Document the actions in the WCAP.
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EXAMPLE 1:
In August 2007 provider Mary calls and says she got her payment and realized she billed 12 instead of 22 units for child Bobby for July 2007. She thinks she mis-typed the number when she called Invoice Express. The AW may want to ask if Bobby missed more than five days or if the provider was closed in July. The request was processed based on the phone call.
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EXAMPLE 2:
In September 2007, Family Home provider Peggy attends a Subsidy Billing Training. After the training Peggy thinks she billed absent days incorrectly for the last two years. She believes she should get 22 units for all the children she cared for. Peggy wants DSHS to figure out how much the state owes her for each child for the last two years. Peggy doesn't remember all the children she cared for but she says the office should have the records.
It is Peggy's responsibility to review her records and give the state enough specific information to review her request. Determine what Peggy needs to supply for the worker to review. Send Peggy a letter outlining what she needs to provide in order to process her request.
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