Service Month

1
Provider Direct Billing Workflow DRAFT

Service Month
1st 5th
6th 15th
16th 20th
21st EOM
Finalize Monthly Authos ensure all data entry
is complete before generating Service
Orders Generate Serv Orders and inform Provider
Run Service Delivery Rpts to ID Provider
billing status
Adjust SAMS data to reflect additional
authorizations
Finalize Bill Generate Agency Invoices
Verbal Service Authos Suspensions Schedule
Changes Data Entry
ASAP
SIMS
Confirm Final Bill Amount
Sync Serv Plan
Provider Direct
Remediation Activity
Resubmit fixed items Second pass remediation
if needed Provide ASAP with the finalized
billed amount
Verbal updates to ASAP Suspensions Schedule
Changes Retrieve PD Authos Discrepancy
Review Perform Services
Adjust for post month authos Prepare Deliveries
Provide ASAP w/ Monthly Billing Coversheet
before upload PD Service Delivery Due Issue Log
Generation Issue remediation due
Run Delivery Rpts to finalize anticipated
payment
PROVIDER
Discrepancies in service plan data between
provider and ASAP need to be identified,
communicated and fixed throughout the service
month. Billing Disputes Depending on the
complexity of the billing dispute, resolution may
or may not happen during the billing period.