Claim Entry

The Claim Entry function is used to enter, modify, and view Center and DCH claims. The system provides the ability to submit claims at the Contracting Entity or site level. Original and upward adjusted claims cannot be submitted if the received date is more than 60-days since the last day of claim month/year. In order to create a claim in a given month, an approved Application Packet must be in effect for the period.

Note: The general claims functionality is the same for both Centers and Day Care Homes.

To access Claim Entry

1. On the blue menu bar, select Claims.

On the Claims menu, select Claim Entry – Centers or Claim Entry -DCH.

If a Contracting Entity has already been selected, the Claim Summary screen displays.
If no Contracting Entity has been selected, use the Contracting Entity Search to search for and select a Contracting Entity.

2. Select the Claim Month you would like to submit a claim. The Claim Month Details screen displays.

Note: The current program year is the default year if no other program year has been selected.

To add an original claim

Claims can be entered for each eligible month in the program year. Eligible months are determined based on an approved Application Packet and the designated application effective date (identified by the State in the Internal Use Only section of the Contracting Entity and Site applications).

1. From the Claims menu, select Claim Entry – Centers or Claim Entry - DCH. The Claim Year Summary screen displays.

2. Select the desired Claim Month. The Claim Month Details screen displays.

3. Select Add Original Claim button. If the Contracting Entity is performing CE-level claiming, the Claim for Reimbursement screen displays.

If the Contracting Entity is performing site-level claiming, the Claim Site List screen displays. Under Actions, select Add to the left of the Site Name you wish to add an original claim. The Claim for Reimbursement screen displays.

Note: The Add Original Claim button will only display on Claim Month Details screens that currently have no claims created.

4. Enter claim information for all enrolled programs. Only the programs identified in an approved Application Packet with the appropriate effective date will be available for data entry.

5. Select Save. The Claim Month Details screen displays.

6. Review the information.

To make a modification or correction to the claim, select the <Back button to return to the Claim for Reimbursement screen.

To submit the claim, check the Certification box and select the Submit for Payment button.

Note: When the Submit for Payment button is selected, the system performs additional edit checks (e.g., 60 day rule, etc.). If the system identifies errors, the errors must be corrected before the user can submit the claim for payment.

WARNING: An original claim cannot be submitted by a Contracting Entity if the received date is more than 60-days since the last day of claim month/year. For exceptions to this rule, contact the TX-UNPS Help Desk.

To modify an un-processed claim

Claims can be modified as many times as desired until the claim has been submitted and processed by the State for payment distribution.

1. From the Claims menu, select Claim Entry – Centers or Claim Entry - DCH. The Claim Year Summary screen displays.

2. Select the desired Claim Month. The Claim Month Details screen displays.

3. If the Contracting Entity is performing CE-level claiming, select Modify. The Claim for Reimbursement screen displays.

If the Contracting Entity is performing site-level claiming, the Claim Site List screen displays. Under Actions, select Modify to the left of the Site Name you wish to view. The Claim for Reimbursement screen displays.

Note: The Summary link is not active until a claim has been submitted with no errors.

4. Update claim information.

5. Select Save. The Claim Month Details screen displays.

6. Review the information.

To make a modification or correction to the claim, select the <Back button to return to the Claim for Reimbursement screen

To submit the claim, check the Certification box and select the Submit for Payment button.

To revise a processed Contracting Entity-level claim

Claim revision resulting in a downward adjustment may be submitted at any time. Claim revisions resulting in an upward adjustment may be submitted if the date of submission is within 60 days of the last day of the original claim month. Revised claims must be re-processed by the State regardless of their original status.

1. From the Claims menu, select Claim Entry – Centers or Claim Entry - DCH. The Claim Year Summary screen displays.

2. Select the desired Claim Month. The Claim Month Details screen displays.

3. If the Contracting Entity is performing CE-level claiming, select Add Revision button. The Claim for Reimbursement screen displays.

If the Contracting Entity is performing site-level claiming, the Claim Site List screen displays. Under Actions, select Revise to the left of the Site Name whose claim you wish to revise. The Claim for Reimbursement screen displays.

Note: The Add Revision button will only display on Claim Month Details screens that currently have no claims created.

4. Make any necessary changes to the claim.

5. Select Save. The Claim Month Details screen displays.

6. Review the information.

To make a modification or correction to the claim, select the <Back button to return to the Claim for Reimbursement screen

To submit the revised claim, check the Certification box and select the Submit for Payment button.

Note: Revised claims must be re-processed by the State regardless of their original status.

WARNING: An upward adjusted claim cannot be submitted by a Contracting Entity if the received date is more than 60-days since the last day of claim month/year. For exceptions to this rule, contact the TX-UNPS Help Desk.

To view a claim

1. From the Claims menu, select Claim Entry – Centers or Claim Entry - DCH. The Claim Year Summary screen displays.

2. Select the desired Claim Month. The Claim Month Details screen displays.

3. If the Contracting Entity is performing CE-level claiming, select View. The Claim for Reimbursement screen displays.

If the Contracting Entity is performing site-level claiming, the Claim Site List screen displays. Under Actions, select View to the left of the Site Name you wish to view. The Claim for Reimbursement screen displays.

To view a Claim Summary

The Claim Summary allows you to view a summary of the month’s claim in an easy-to-read or print format. No modifications can be made from this page. A Claim Summary is not available until a claim has been submitted with no errors.

1. From the Claims menu, select Claim Entry – Centers or Claim Entry - DCH. The Claim Year Summary screen displays.

2. Select the desired Claim Month. The Claim Month Details screen displays.

3. Select Summary. The Claim for Reimbursement Summary screen displays.

To delete a claim

If the Contracting Entry has entered a claim in error and the claim has not been included in the batch payment process (i.e., the status of the claim is NOT “Accepted*” or “Processed”), the claim can be deleted.

1. From the Claims menu, select Claim Entry – Centers or Claim Entry - DCH. The Claim Year Summary screen displays.

2. Select the desired Claim Month. The Claim Month Details screen displays.

3. If the Contracting Entity is performing CE-level claiming, select Modify. The Claim for Reimbursement screen displays.

If the Contracting Entity is performing site-level claiming, the Claim Site List screen displays. If you wish to delete a claim for only one of the sites, under Actions, select Modify to the left of the Site Name you wish to view. (If you wish to delete the entire claim, skip this step.) The Claim for Reimbursement screen displays.

4. Select Delete in the Edit menu in the upper-right corner.

5. The system transfers you to the bottom of the screen and a warning message is displayed.

6. Select the Delete button at the bottom of the page. A confirmation message displays.

7. Select Finish.