AP & AR
Netting is this.
What is recouping/withholding money owed from future payments?
This is a provider, member, or organization who receives payment from the District.
Who is a vendor?
A claim with a suffix of R1 is this type of claim.
What is the first reversal of the original claim?
Payment cycles are kicked off in this system that integrates with Finance Manager.
What is Administrator?
Following an approved EFT change, this is done to checks to help identify fraud attempts before an attacker receives stolen funds.
What is checks are dropped to paper?
Payment Plan on the VUE360 Receivable Entry Field equates to this on the Finance Transaction Request Form Fields.
What is Pay Terms?
These are providers, members, or organizations that owe money to the District.
Who are customers?
This is the timely filing limit for a Medicaid claim that is a Medicare crossover claim.
What is 180 days?
The payment cycle is a combination of these two things.
What are automated systems and human interventions?
This document is sent to a healthcare provider to explain payments received and any adjustments made by the payer.
What is a remittance advice?
Once an accounts payable invoice is created, it is moved to a queue under this subtab under Accounts Payable in VUE360 for review and posting.
What is Payable Approval subtab?
Providers have this many days to dispute Medicare disallowance.
What is 30 days?
These are often caused by incorrectly coded claims or claims that were billed twice and are one of the most frequent reasons for Accounts Receivable balances.
What are overpayments?
Remittance Advices are generated on this day of the week during the payment cycle.
What is Thursday?
Many Finance reports are run here in VUE360.
What is Supporting Systems-->SSRS Reporting?
The Distribution Rule field on the VUE360 Payable Entry field is the same as this field on the Finance Transaction Request Form.
What is the Fund Code?
If a Medicaid beneficiary is hospitalized following a car accident and has employer-sponsored health insurance, Medicaid, and auto insurance with medical coverage, this coverage should pay primary on their accident-related claims.
What is their auto insurance with medical coverage?
These are standardized reason codes used on remittance advices to explain claim outcomes, including denials.
What are CARCs and RARCs?
These types of financial transactions must remain fully traceable and meet federal audit standards in order to comply with Medicaid regulations.
What are manual financial transactions?
These are similar to manilla folders and contain all information related to a specific task in Process Manager/Workflow Manager.
What are Work Objects?
Accounts payable imports are submitted through this process to ensure data is accurately transferred into the Finance Manager system.
What is Extract, Transform, Load (ETL)?
These are the next steps on claims that are involved in the Medicare disallowance process if the provider does not appeal.
What is the claims are unlocked and reversed?
These are conducted by the Centers for Medicare & Medicaid Services (CMS) and focus on verifying eligibility, checking the accuracy of claims, ensuring financial integrity, and reviewing system security and access controls.
What are audits?
This process includes running a report every Thursday in Report Manager to identify payments that have not yet had checks issued.
What is the Payment Reconciliation Process?
During this phase of the claims lifecycle, rate and price indicators are used to calculate the final payment amount in accordance with any prior authorization rates.
What is Pricing?