Payment Statuses
All payments have a status that defines where it is in the payment workflow and what can happen to it.
1. Deleted:
The "Deleted" status means the provider chose to delete the payment. Deleted payments are not physically removed from the database. Instead, they are marked as "Deleted" and forever remain that status. A "Deleted" payment cannot be reconstituted. Consequently, if the provider wishes to be paid for the service the "Deleted" payment would have covered, they must resubmit it.
2. Denied by DSPD:
If DSPD determines the payment was submitted in error or the payment is not valid as it was submitted, they can deny it. Denied payments are not physically removed from the database. Instead, they are marked as "Denied by DSPD" and forever remain in that status. Consequently, if the provider wishes to be paid for the service marked as "Denied by DSPD", they must resubmit it.
3. Denied by SC:
If the support coordinator determines the payment was submitted in error or the payment is not valid as it was submitted, they can deny it. Denied payments are not physically removed from the database. Instead, they are marked as "Denied by SC" and forever remain in that status. Consequently, if the provider wishes to be paid for the service marked as "Denied by SC", they must resubmit it.
4. Error:
A payment marked as "Error" means it failed either the USTEPS and/or the CAPS data validation process. Depending on the nature of the error, the payment can be resubmitted if the cause of the problem is corrected. For example, if the payment fails the validation process because the number of units on the payment exceeds the service code's Monthly Max on the PCSP Budget, then the provider can notify the support coordinator about the problem. The support coordinator, in turn, can update the service code's Monthly Max on the PCSP Budget and then approve the payment.
5. Error by CAPS:
Even though the data validation requirements for USTEPS and CAPS run at every stage of the payment process (i.e. at the point of its original submission, at the point of the support coordinator's approval, and at the point of DSPD's approval), CAPS may still find a problem with the payment during the standard Wednesday night payment run. The possibility exists because of the remote chance something about the provider's contract, provider approvals, etc., may change in CAPS / the Bureau of Contract Monitoring System (BCMS) midstream ultimately causing the payment to become incompatible with the change. If CAPS finds the payment has an error, it does not process the payment and the status of such a payment in UPI becomes "Error by CAPS". In practical terms, a payment denied by CAPS means it will forever remain in that status. If the provider wishes to be paid for the service marked as "Error by CAPS", they must resubmit it.
6. Held by CAPS:
The Office of Fiscal Operations (OFO) in the Department of Human Services (DHS) has authority to define the policies and procedures by which it authorizes payment to providers for services rendered in behalf of people served by DHS agencies. One policy it enforces is the withholding of payment for a service previously authorized and approved. The decision to withhold a payment can be done for a variety of reasons. If a payment is placed on hold in CAPS, it status in UPI is changed to "Held by CAPS".
7. Rejected by CAPS:
Even though the data validation requirements for USTEPS and CAPS run at every stage of the payment process (i.e. at the point of its original submission, at the point of the support coordinator's approval, and at the point of DSPD's approval), CAPS may still reject the payment during the standard Wednesday night payment run. The possibility exists because of the remote chance something about the provider's contract, provider approvals, etc., may change in CAPS / the Bureau of Contract Monitoring System (BCMS) midstream ultimately causing the payment to become incompatible with the change. If CAPS rejects the payment, it does not process the payment and the status of such a payment in UPI becomes "Rejected by CAPS". In practical terms, a payment rejected by CAPS means it is denied and will forever remain in that status. If the provider wishes to be paid for the service marked as "Rejected by CAPS", they must resubmit it.
8. Review:
If a payment is placed in "Error" status and the provider wishes the support coordinator to correct the problem that caused the error to occur, they can send the payment to the support coordinator with a note explaining what needs to be done. For example, if the payment failed the validation process because its units are greater than the service code's monthly max on the PCSP Budget, the provider can send the payment to the support coordinator with a note explaining how the monthly max should be changed. When the provider sends a payment in error status to the support coordinator, its status is automatically changed to "Review". A payment in "Review" status means it is waiting for the support coordinator to review its underlying problem. Then, they must either correct the problem and approve the payment or deny the payment.
9. Paid by CAPS:
When CAPS successfully processes the payment during its normal payment run Wednesday evening, its status is changed to "Paid by CAPS".
10. Submitted to CAPS:
When DSPD approves the payment and it successfully passes all of the payment validations, its status is automatically changed to "Submitted to CAPS". A payment in this status means it is a pending payment waiting to be processed by CAPS during its normal payment run Wednesday evening.
11. Waiting DSPD Approval:
After the support coordinator approves the payment and it successfully passes all of the payment validations, its status is automatically changed to "Waiting DSPD Approval". A payment in this status means it is waiting for the DSPD payment technician to review and either approve or deny it.
12. Waiting SC Approval:
After the provider has submitted the payment and it successfully passes all of the payment validations, its status is automatically changed to "Waiting SC Approval". A payment in this status means it is waiting for the support coordinator to review and either approve or deny it.