Boxing Ring

Overview:

Functionality for Lead Agencies to flag services for recoupment has been introduced. Once the Lead Agency notifies the Vendor of a recoupment, the Vendor will have 14 days to take action on the record else the record will be recouped automatically.  For any action taken by Lead Agencies after the initial notification, Vendors will have 7 days to respond else the record will be recouped automatically.  For any action taken by Vendors, Lead Agencies will have 7 days to respond else the petition will be automatically accepted (i.e. the record will not be recouped). 

In order for a Lead Agency to flag records for recoupment, they must first contact the Vendor to inform them.  The Lead Agency will have to enter in the system whom they spoke to and when in order for records to be considered 'Flagged' and appear for the Vendor to review. 

Vendors can petition records flagged for recoupment and attach supporting documentation to accommodate the petition. 

After a petition is made, the Lead Agency can request clarification on the petition.  The Lead Agency may or may not require the Vendor to include supporting documentation as part of clarification. 

Vendors and Lead Agencies can go back-and-forth between 'Clarification Required' and 'Clarification Provided' as many times as necessary. The Lead Agency can also choose at any time to 'force' a recoupment. 

Vendors can choose to accept the recoupment, in which case they agree to repay the aggregate amount via future payment offsets, direct reimbursement, or a combination of both. 

To Open the Boxing Ring:

 From the Home screen:

1.  Click the QA Review drop-down.

2. Click Boxing Ring.

   Open

   

3. Click the Provider field and enter a provider.

4. Click the Status field and click status.

5. Click the Read field and click read status.

6. Click Group by field and click grouping.

7. The system displays records for that Vendor
   
   

   Open

   

8. Click a record to see details in the Record Status, Record Details, and Record History sections. (Clicking the record will also mark it as Read when clicked for the first time)

9. Click the ^ icon of each section to expand/hide the section as needed.

10. Enter data in the search criteria fields on the top of the screen to search for specific records.

Record Icon Definitions

Record Action Timeline:

Vendors have 7 days to Accept or Petition to Records marked for Recoupment. If they do not Accept or Petition within 7 days the system will auto-recoup the records.

Vendors have 7 days to Submit Clarification on Records marked for Clarification by the Lead Agency. If they do not submit within the 7 days the system will auto-recoup the records.

The Record Status section for each Record will display the # of days remaining in the 7-day countdown.

To Read/Unread Record(s) marked for Recoupment:

1. Click the Record(s) in the Envelope column to highlight and mark as Read or Unread.

To Notify Vendor on Record(s) marked for Recoupment:

1. Click the Record(s) in the Checkmark column to highlight.

2. Click Vendor Notified.

3. Click the Who did you speak with field and enter the contact person’s name.

4. Click the When did you speak to him/her date calendar and click date.

5. Click Submit.

6. The status icon for the record(s) will change from an hourglass to an orange triangle.

To Request Clarification on Record(s) marked for Recoupment:

1. Click the Record(s) in the Checkmark column to highlight.

2. Click Request Clarification.

3. Click the 'What is required before the petition can be considered?' field and enter information.

4. Click the Are supporting documents required as part of the clarification and click Yes or No.

5. Click the file upload field or drag and drop to add supporting documents. (To delete an attachment click the trash can icon next to the document)

6. Click Submit to confirm the clarification request.

7. The status icon for the record(s) will change from a P to a ?.

To Recoup Record(s) marked for Recoupment:

1. Click the Record(s) in the Checkmark column to highlight.

2. Click Recoup.

3. Click the Why are the selected records being forced to the repayment process field and enter information.

4. Click Submit.

To Cancel/Not Recoup Record(s) marked for Recoupment:

1. Click the Record(s) in the Checkmark column to highlight.

2. Click Don’t Recoup.

3. Click Submit.

To Export Record(s) marked for Recoupment to Excel:

1. Click the Record(s) in the Checkmark column to highlight.

2. Click Export to CSV.

3. An excel CSV file will be displayed.

Questions

For any questions email support@fallingcolors.com