Researching Payment Problems

A payment can be placed in "Error" status for a number of reasons. Four of the most common reasons are the payment has been duplicated, the payment has been overspent, the payment's units exceed the service code's monthly max on the PCSP budget and the payment's start/end dates and/or rate are not compatible with a line on the PCSP budget. When a payment has failed the validation process, the support coordinator and/or the provider must identify the cause of the problem and then resolve it. The guidelines below are designed to assist in the resolution process.

Scenario #1: The provider submitted a legitimate payment electronically. The payment passed the validations and then was sent on to you to approve. Then, a couple of hours or days later, the provider inadvertently submitted the same payment again (or a similar one for the same person / service with overlapping dates). In this situation, the system will put the second payment in "Error" status while the other is in "Waiting SC Approval" status.

Resolution: Since both payments exist at nearly the same stage of the payment process, you have to work with the provider to determine which one they want to kept and which one should be discarded.

Scenario #2: The provider submitted two payments in the same batch for the same person / service and they have overlapping dates.

Resolution: The system automatically places both payments in "Error" status as duplicates of each other. The provider should resolve the duplicate issue before they involve you (meaning they should delete one payment and resubmit the other). If they do send the payment to you in "Review" status, then you should have the same conversation about which payment they want to keep and which they want to delete - meaning they need to delete one of them before you attempt to approve the other.

Scenario #3: The provider submits a payment for a service that has already been approved by you and DSPD and is currently sitting in CAPS waiting to be processed (or has already been paid by CAPS).

Resolution: In this scenario, the newly submitted payment that exists as a duplicate of the one in CAPS should be deleted by the provider. But, if the provider sends it to you in "Review" status, you may have to do a little more work to find where the other payment is at. If the provider does this, then you can reject the payment after verifying what the condition of the other payment is.

If the payment overspent the units prescribed for the service, then it means exactly that. The validations do not compare the payment against the sum of all the units prescribed for all of the service code's budget lines. Instead, it compares the payment against the units prescribed for the single line on the PCSP Budget it falls within. Overspending happens because of one of two possibilities.

1. The provider delivered more units than were authorized in the 1056. The resolution for this issue is to either request additional funding to cover the cost or to deny the payment outright because the provider was not authorized to deliver the amount of service indicated on the payment.

2. The support coordinator made a mistake in prescribing the units for the service in the PCSP Budget because they do not agree with how the provider is delivering the service and the provider is delivering the service within the original scope it was authorized. The resolution for this issue is to correct the unit prescription error such that they match payment history.

If the payment's units exceed the service code's month max on the PCSP budget, then it means exactly that.

The resolution for this issue requires the support coordinator to change the service code's monthly max on the PCSP budget to be compatible with the units on the payment up to 999 (the maximum number of units CAPS allows any payment have)

If the payment does not match a valid budget line in the PCSP budget, the cause can be any of the following:

1. The service code does not exist on the person's PCSP budget. If the provider billed the payment incorrectly, the resolution is to delete the payment and submit the correct payment. However, if the support coordinator failed to load the service correctly on the PCSP budget, then they must correct the plan and then approve the payment.

2. The payment's start and/or end dates are outside the start and/or end dates of the service code's line on the PCSP budget. If the provider billed the payment incorrectly, the resolution is to delete the payment and submit the correct payment. However, if the support coordinator failed to load the service correctly on the PCSP budget, then they must correct the plan and then approve the payment.

3. The payment's rate is not equal to or less than the service code's rate on the PCSP budget. If the provider billed the payment incorrectly, the resolution is to delete the payment and submit the correct payment. However, if the support coordinator failed to load the service correctly on the PCSP budget, then they must correct the plan and then approve the payment.

4. The payment's unit type does not match the service code's unit type on the PCSP budget. If the provider billed the payment incorrectly, the resolution is to delete the payment and submit the correct payment. However, if the support coordinator failed to load the service correctly on the PCSP budget, then they must correct the plan and then approve the payment.