Process Service Claim Payments


Claims submitted to <<MMIS/State>> for payments made on behalf of consumers for tax purposes are referred to as service claims. 

On a weekly basis, or as payments for service claims are received by F/EA, <<Staff Title>> loads the electronic payment remittance file to Billing System. The payment is reconciled to open claims in Billing System. Any denied claims are noted, accounted for and researched.
Open claims in the ETS billing system are reconciled to the Accounts Receivable on the Wash Claim billing control sheet. After reconciling and resolving any discrepancies, <<Staff Title>> creates a journal entry template to post the service claim payments to the General Ledger.
After reviewing the journal entry template and supporting documents, the <<Staff Title>> and F/EA Accountant sign and date the journal entry template. The F/EA Accountant posts payments to the General Ledger (See Policy and Procedure 20.5).
After posting payments, a reconciliation of the General Ledger account to ETS Accounts Receivable is performed (See Policy and Procedure 2.15).

Post Service Payment to Billing System

<<Process will vary depending on State payment process and F/EA billing system and processes>>

Internal Controls: 

The internal controls used by F/EA to monitor this process establish responsibility, segregate duties, document procedures and ensure independent internal verification.

  1. <<Staff Title>> reconciles Cash Account Transactions-Batch Control report to Remittance Advice to the electronic payment file to ensure payment file has been received appropriately.
  2. <<Staff Title>> reconciles payment file that has been applied to open service claims to remittance advice to ensure payment claims were not misapplied to open claims.
  3. <<Staff Title>> enters all values in a billing control document.
  4. <<Staff Title>> reconciles the Accounts Receivable report to billing control document to ensure that all payments and denials have been correctly accounted for.
  5. Paper and electronic copies of all documents are maintained for a minimum of 7 years per File Retention Policy.