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Submit Service Claims to <<MMIS, State, Other>>

Policy: 

On a weekly basis, <<Staff Title>> produces a claim file for all payrolls processed in the most recent payroll cycle and any claims that were put on hold from a previous payroll cycle. Claims are produced per the format for electronic submission as specified by State/MMIS Provider. 

Each claim is verified for accuracy, completeness and compliance with program rules and regulation prior to submission. Claim file submissions are recorded in a control sheet.
 
After submitting a claim, a journal entry template is created and a posting made to the General Ledger.
Procedure: 

Process will vary based on program rules and F/EA systems.

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. System access is restricted to those staff who have direct responsibility for service claim production
  2. Before completing the current payroll cycle’s billing, values in the billing system are reviewed to ensure that the billing from the last cycle was completed
  3. Each daily bill file is reconciled to the daily payroll report
    • Discrepancies are researched and resolved prior to proceeding
  4. Adjustments are made using control documents provided by the Payroll Department
    • All adjustments are stored for reconciliation purposes
  5. <<Staff Title>> reconciles supporting documents to ensure billing is submitted appropriately and payments are applied to claims appropriately.
  6. <<Staff Title>> creates journal entry templates.
    • Each journal entry template is used as a control document.
    • Each reconciliation document is prenumbered
    • <<Staff Title>> signs and dates verifying accuracy
  7. F/EA Accountant reviews supporting documents and journal entry template for completeness and mathematical accuracy.
    • F/EA Accountant signs and dates journal entry template.
  8. <<Staff Title>> reviews supporting documents and journal entry template for completeness and mathematical accuracy.
    • <<Staff Title>> signs and dates journal entry template.
  9. F/EA Accountant posts journal entries.
  10. F/EA Accountant reconciles General Ledger to appropriate supporting documents at year-end.
  11. F/EA Accountant produces reconciliation documents, verifies, signs and dates.
  12. <<Staff Title>> reviews, verifies, signs and dates reconciliation documents