Filetype Excel XLSX | Posted on 09 Aug 2022 | 3 years ago
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270x Filetype XLSX File size 0.05 MB Source: ahca.myflorida.com
Sheet 1: Instructions
| INSTRUCTIONS FOR COMPLETING CLAIMS AGING TEMPLATE |
| REPORT MMA AND LTC AS APPROPRIATE |
| This template computes an aging claims analysis on a quarterly basis. |
| Basis for Reporting: Report at the claim line level. |
| Clean Claim = A claim that can be processed without obtaining additional information from the provider of the service or from a third party. It does not include a claim from a provider who is under investigation for fraud, abuse, or a claim under review for medical necessity. |
| For paid claims, the date of payment is the check date for payments issued by check. For electronic payments (ACH or wire), the date of payment is the date the payment file (or similar file) is delivered to the financial institution. For denied claims, the applicable date is the date of denial. |
| The claims data should NOT be run for this report until at least 31 days after the end of the reporting quarter but before the due date for filing the report (45 days after the end of the reporting quarter). |
| The claims data MUST be MEDICAID only. |
| 1. Cover Sheet - Input information for the plan's name, quarter ending, plan's 7 (seven) digit provider ID number, and the date the data was run for the quarterly report. |
| 2. MMA - Enter ALL MMA claims with a received date that corresponds to the dates of the report quarter. The sheet is broken out by Electronic and Non-Electronic receipt of claims, as well as total. |
| 3. LTC - Enter ALL LTC claims with a received date that corresponds to the dates of the report quarter. The sheet is broken out by Electronic and Non-Electronic receipt of claims, as well as total. |
| ** Only the Yellow cells are for input. |
| Type Codes: |
| PRIMARY CARE = REPORT IN SUMMARY |
| SPECIALTY = REPORT IN SUMMARY |
| OTHER = REPORT IN SUMMARY |
| HOSPITAL = REPORT IN SUMMARY |
| NURSING FACILITY/HOSPICE = REPORT IN SUMMARY |
| For questions or assistance with this report, please contact your plan's Contract Manager. |
| File the template in its entirety to the Agency via the SMMC SFTP site by the due date (45 days after the end of the reporting quarter). |
| Medicaid Claims Aging Report | ||||
| Plan Name: | ||||
| SMMC MMA | ||||
| Contact Person: | SMMC LTC | |||
| Telephone: | ||||
| E-Mail: | ||||
| Fax: | ||||
| For the quarter ending: | ||||
| **Quarterly Report Data Run Date: | ||||
| 7-Digit Base Provider ID#: | ||||
| Comments/Notes: | ||||
| Plan Name | MANAGED MEDICAL ASSISTANCE (MMA) | |||||||||||||||||||||||||
| Quarter Ending | ||||||||||||||||||||||||||
| ELECTRONICALLY SUBMITTED CLAIMS | ||||||||||||||||||||||||||
| ELECTRONIC CLAIMS PAID/DENIED WITHIN 7 CALENDAR DAYS | ELECTRONIC CLAIMS PAID/DENIED WITHIN 10 CALENDAR DAYS | ELECTRONIC CLAIMS PAID/DENIED WITHIN 20 CALENDAR DAYS | ELECTRONIC CLAIMS PAID/DENIED WITHIN 90 CALENDAR DAYS | |||||||||||||||||||||||
| Provider | NO. OF CLAIMS PROCESSED | CLAIMS PAID WITHIN 7 CALENDAR DAYS | % | CLAIMS DENIED WITHIN 7 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 7 CALENDAR DAYS | % | CLAIMS PAID WITHIN 8-10 CALENDAR DAYS | CLAIMS DENIED WITHIN 8-10 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 8-10 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 10 DAYS | % | CLAIMS PAID WITHIN 11-20 CALENDAR DAYS | CLAIMS DENIED WITHIN 11-20 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 11-20 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 20 DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 90 DAYS | % | |||
| Primary Care | 0% | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | |||||||||
| Specialty | 0% | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | |||||||||
| Hospital | 0% | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | |||||||||
| Other | 0% | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | |||||||||
| Total | 0 | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | |
| NON-ELECTRONICALLY SUBMITTED CLAIMS | ||||||||||||||||||||||||||
| NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 7 CALENDAR DAYS | NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 10 CALENDAR DAYS | NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 20 CALENDAR DAYS | NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 120 CALENDAR DAYS | |||||||||||||||||||||||
| Provider | NO. OF CLAIMS PROCESSED | CLAIMS PAID WITHIN 7 CALENDAR DAYS | % | CLAIMS DENIED WITHIN 7 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 7 CALENDAR DAYS | % | CLAIMS PAID WITHIN 8-10 CALENDAR DAYS | CLAIMS DENIED WITHIN 8-10 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 8-10 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 10 DAYS | % | CLAIMS PAID WITHIN 11-20 CALENDAR DAYS | CLAIMS DENIED WITHIN 11-20 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 11-20 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 20 DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 120 DAYS | % | |||
| Primary Care | 0% | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | |||||||||
| Specialty | 0% | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | |||||||||
| Hospital | 0% | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | |||||||||
| Other | 0% | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | 0% | 0 | 0% | 0 | 0% | 0% | |||||||||
| Total | 0 | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | |
| TOTAL CLAIMS RECEIVED | ||||||||||||||||||||||||||
| TOTAL CLAIMS PAID/DENIED WITHIN 7 CALENDAR DAYS | TOTAL CLAIMS PAID/DENIED WITHIN 10 CALENDAR DAYS | TOTAL CLAIMS PAID/DENIED WITHIN 20 CALENDAR DAYS | ||||||||||||||||||||||||
| Provider | NO. OF CLAIMS PROCESSED | CLAIMS PAID WITHIN 7 CALENDAR DAYS | % | CLAIMS DENIED WITHIN 7 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 7 CALENDAR DAYS | % | CLAIMS PAID WITHIN 8-10 CALENDAR DAYS | CLAIMS DENIED WITHIN 8-10 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 8-10 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 10 DAYS | % | CLAIMS PAID WITHIN 11-20 CALENDAR DAYS | CLAIMS DENIED WITHIN 11-20 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 11-20 CALENDAR DAYS | % | TOTAL CLAIMS PROCESSED WITHIN 20 DAYS | % | |||||
| Primary Care | 0 | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | |||
| Specialty | 0 | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | |||
| Hospital | 0 | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | |||
| Other | 0 | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | |||
| Total | 0 | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | |||
