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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.11 Remittance and Status (R&S) Report : 6.11.4 R&S Report Section Explanation : 6.11.4.4 Claims Payment Summary

6.11.4.4
Claims Payment Summary
This section summarizes all payments, adjustments, and financial transactions listed on the R&S Report. The section has two categories: one for amounts “Affecting Payment This Cycle” and one for “Amount Affecting 1099 Earnings.”
If the provider is receiving a check on this particular R&S Report, the following information is given: “Payment summary for check XXXXXXXXX in the amount of XXX,XXX,XXX.XX.” If the payment is EFT: “Payment summary for direct deposit by EFT XXXXXXXXX in the amount of XXX,XXX,XXX.XX.” The check number also is printed on the check that accompanies the R&S Report.
Headings for the Payment Summary for “Affecting Payment This Cycle” and
“Amount Affecting 1099 Earnings”
Claims Paid. Indicates the number of claims processed for the week and the year-to-date total.
System Payouts. The total amount of system payouts made to the provider by TMHP.
Manual Payouts (Remitted by separate check or EFT). The total amount of manual payouts made to the provider by TMHP.
Amount Paid to IRS for Levies. The amount remitted to IRS and withheld from the provider’s payment due to an IRS levy.
Amount Paid to IRS for Backup Withholding. The amount paid to the IRS for backup withholding.
Accounts Receivable Recoupments. The total amount withheld from the provider’s payment due to accounts receivable.
Amounts Stopped/Voided. The total amount of the payment that was voided or stopped with no reissuance of payment.
System Reissues. The amount of the reissed payment.
Claim Related Refunds. The total amount of claim-related refunds applied during the weekly cycle.
Nonclaim Related Refunds. The total amount of nonclaim-related refunds applied during the weekly cycle.
Approved to Pay/Deny Amount. The total amount of claim payments that were approved to pay/deny within the week. (This column will not be used at this time.)
Pending Claims. The total amount billed for claims in process as of the cutoff date for the report.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.