Payment Adjustments
Our goal is to keep manual claim processes to a minimum because they are very time intensive and delay appropriate payments to providers. If too many manual claims are completed each month, it defeats the purpose of an automated system.
Manual claims should be kept to a minimum when applications are processed within 2 working days from the date all necessary verification is provided and child care benefits are reopened quickly when eligibility is renewed per policy.
You can further help reduce manual claims by:
- Encouraging clients to choose child care providers who already have POS equipment installed;
- Making positive changes to a client’s copayment or authorization as soon as you are aware of them. Be sure to enter the correct effective date in each section if at all possible. Remember policy states a change must be reported timely in order to go back further than the current month to increase services;
- Correctly processing copayment changes. The Child Care tab in FACS will allow workers to make changes back to the first day of the current month for copayment decreases;
- Correctly processing authorization changes. Changes to the authorizations to increase the number of days and unit type can be made as far back as necessary;
- Properly entering birthdates for children to ensure accuracy;
- Never entering duplicate authorizations covering the same time period for the same provider; and
- Emphasizing with clients the need to swipe attendance daily and to report any denied swipes to you immediately.
Staff from the Finance Division uses a manual claim process whenever the EBT- system for Child Care does not pay correctly. The provider requests adjustments using Form 10AD121E, Child Care Claims (ADM-12-S). (The provider must use the 2015 version of the ADM-12-s or newer.) The worker requests adjustments using Form 10EB004E, Report of EBT Child Care Payment Adjustments (EBT-4).
The chart below describes when payment adjustment forms are needed, what form should be used and who should submit the request. The ADM-12-S is submitted when there are denied swipes on a case that the client could not correct with previous in and out swipes. The EBT-4 is only used when money is owed to the provider and the client swiped correct attendance. If the provider was paid too much money because the client’s copayment was not recorded correctly, a client overpayment is submitted by the worker to the AFS Benefit Integrity & Recovery Unit.
The Finance Division will track the reasons manual adjustments are submitted to help determine how to reduce the need for using the forms. If an inordinate number of manual adjustments occur in certain counties, action plans may be required.
The Finance Division will not pay providers for days attendance was not swiped by the client when no extenuating circumstances exist.
| Problem | Explanation | Solution | Form Needed |
| POS not issued | Client uses a provider who has not been issued a POS machine.* | Enter authorization on the system.
Reminder: If the provider has confirmed they have requested a POS machine but are still waiting, the parent can download the ECC App to record attendance if the provider allows. |
ADM-12-S
(Provider submits) |
| Attendance not recorded | Attendance could not be recorded on the system because of a reason outside of the client and/or provider’s control OR due to agency error. |
|
ADM-12-S
(Provider submits) |
| Authorization pending more than 90 days | The swipes have shown the error message “pending” more than 90 days and the authorization is later approved. |
|
EBT-4
(Worker submits) |
| More than one authorization for the same provider | The worker entered more than one authorization for the same period of time for the same provider AND the client swiped correct attendance that was denied. | Submit a Remedy Ticket immediately so action can be taken to un-overlap the authorizations. | EBT-4
(Worker submits) |
| Reopening further back that 10 days | Child care services are reopened within 30 days of closure because of reconsideration of administrative action policy AND client swiped correct attendance that was denied. | Reopen child care authorization using reopen code. | ADM-12-S (Provider submits) |
| Increasing number of days or type of units | Positive changes were made to the authorization to increase number of days or type of care AND the client swiped correct attendance (even if denied). | Make appropriate changes to the authorization effective the first day of the month the change should have occurred. | EBT-4 (Worker submits)*Note: Provider would not submit an ADM-12-S for denied swipes in this instance since they are connected to the coding change. The EBT-4 is submitted by the worker and Finance will take care of any denied swipes. |
| Too much co-payment | Reimburse provider because more copayment was assessed on the POS machine than the client actually owed or was properly notified he/she owed. | Make a change to the Child Care tab in FACS to reflect the correct copayment effective the first possible date. (The system will allow a change back to the first of the current month if appropriate.) | EBT-4
(Worker submits) |
| Wrong rate – birth date | The provider is paid at the wrong rate because of incorrect coding to a child’s date of birth. | Change birth date the next effective date. | EBT-4
(Worker submits) |
| Wrong rate – start status | The provider is paid at the wrong rate because of the incorrect facility star status. | Check with AFS Help Desk to determine if the authorization should be pushed. | EBT-4
(Worker submits) |
The following chart deals with some common examples when NEITHER form is required as long as the swipes have recorded time and attendance. Remember, Finance will not pay when swipes have not been made unless there are extenuating circumstances.
| Problem | Explanation | Solution | Form Needed |
| Co-pay on 2 providers | Two providers were authorized for care on the case and copay was applied at both providers because both were coded “N” in the Copay Exempt field. | Change the Copay Exempt field to an “S” on the authorization(s) for the provider giving the least care for the family. For the month the coding was incorrect, the client must pay part of the copayment to each of the providers based on what was applied to each facility. | No Form Needed |
| B4 error Code
(pending) |
The client is certified with a different provider AND client swiped correct attendance. | Enter the authorization for the correct provider when eligibility is determined within 90 days. | No Form Needed |
| EA error code
(pending) |
Authorization is pending with a different provider AND client swiped correct attendance. | Close the authorization at the wrong provider and open an authorization with the current provider. | No Form Needed |
| E4 error code
(pending) |
Child care authorization is pending AND client swiped correct attendance. | Enter authorization for correct provider when eligibility is determined. | No Form Needed |
| E5 error code
(pending) |
No provider is shown on pending authorization AND client swiped correct attendance. | Enter authorization for correct provider when eligibility is determined. | No Form Needed |
Comments or Suggestions?
We want Quest to be your source for important information that you need to succeed at in your work but we need your help:
Was this article helpful? Was it missing something you needed to get the job done?
Tell us what you think, what you know about this article. What are we doing well, and what we could do better.
All fields are required.