ROSIs and PQAs can be adjusted using these steps.
NOTE: Only POSTED invoices can be adjusted
Go to Medicaid Payer->Medicaid Processing->Adjust
By using the filter criteria available, search for the invoice to be adjusted. One form of filtering is required.
After selecting the filter(s) click GO and the invoice(s) will load. Check mark the check box on the left hand side to select the invoice(s) to adjust and click SUBMIT
The user will receive a pop ".Are you sure you want to Adjust the medicaid invoice(s)?" To proceed with the adjustment, click OK. To cancel the request, click Cancel
Click OK to proceed with the adjustment, and load the adjusted invoice. NOTE: if the invoice being adjusted was a ROSI the invoice number will now appear red.
To make changes to the open adjustment invoice:
- On the same page under the filtering options, Change the Action from Adjust to Change to open the invoice for updates
- Go to Medicaid Payer->Medicaid Processing->Change, enter the search criteria for the invoice and click GO.
The user will need to type in the required information (marked with an asterisk). The user is able to change the invoice number on the adjustment only.
Complete the required field in the invoice header, Receive Date and Postmark
After the information is entered, click SAVE and the next page will load on 2. DetailAdj
The products on the invoice from the previous ROSI and adjustments (if any) will appear. The user should only enter data for the products that need to be adjusted using the lines provided. Any products not being adjusted should be ignored. DO NOT UNCHECK A PRODUCT LINE because the product will be deleted from the invoice entirely.
- Original Rebate Per Unit – will display the URA from the ROSI
- Current Rebate Per Unit – will display the URA from Government Pricing. If there was a different URA in GP now as there was at the time the ROSI was processed, the new URA will be displayed
- Original Units Invoiced* - will display the units invoiced from the ROSI
- Current Units to Date – will display the current units invoiced. If the previous invoice was a ROSI, this will be the ROSI invoiced units. If there was an adjustment completed prior to this adjustment, then accumulative invoiced unit amount will display. To adjust the units, type the new accumulative invoiced unit amount
- Current Units Paid to Date - will display the current units paid. If the previous invoice was a ROSI, this will be the ROSI paid units. If there was an adjustment completed prior to this adjustment, then accumulative paid unit amount will display. If the ‘Current Units to Date’ amount is changed, this field will also populate with that value. The user may change this field.
- Original Amt Invoiced – will display the invoiced amount from the ROSI
- Revised Invoice Amt - Current Rebate Per Unit*Current Units to Date
- Prior Units Disputed – will display the units disputed from the ROSI
- Current Units Disputed to Date – will display if any units are now being disputed on this adjustment
- Prior Units Paid – will display the units paid from the ROSI
- Prior Amt Paid – will display the original amount paid from the ROSI
- Current Amt Paid to Date - Current Rebate Per Unit*Current Units Paid to Date
- Amount Paid This Trans – will display the difference between what the accumulative amount paid on the previous invoice and what the accumulative amount paid is now
- Adjm Code – To add an adjustment code, select the ‘+’ adjustment code from the drop down. If an adjustment code needs to be removed, select the ‘-‘ adjustment code from the drop down.
- Disp Code - To add a dispute code, select the ‘+’ dispute code from the drop down. If an dispute code needs to be removed, select the ‘-‘ dispute code from the drop down.
- Number of Prescriptions – type the number of prescriptions for the product. For an adjustment, this will be the new accumulative total
- Medicaid Amount Reimbursed – type the Medicaid Amount Reimbursed (if not provided this can be left blank). For an adjustment, this will be the new accumulative total
- Non-Medicaid Amount Reimbursed – type the Non-Medicaid Amount Reimbursed (if not provided this can be left blank). For an adjustment, this will be the new accumulative total
- Total Amount Reimbursed - Medicaid Amount Reimbursed + Non-Medicaid Amount Reimbursed. The user may also type in this field. For an adjustment, this will be the new accumulative total
- Adj & Disp Code Messages – this will populate if an adjustment code or dispute code is added to the product line
- Validation Messages – after validation any informational or warning messages will be listed per product
After the data is entered for each product, click SAVE.
NOTE: Make sure to not time out before clicking SAVE. If the user has timed out before clicking SAVE, if the user then clicks SAVE the data will be lost. TIP: If the user timed out, open a new tab and sign back in. Then click SAVE.