Medicaid Claims

MSCertAccelerate Medicaid Claim Reimbursements • Consolidated Series of Reports • Reduce Claim Processing Time

Operational in California’s Department of Health Care Services for the last five (5) years, USL’s Medicaid Claims Tracking System has thoroughly modernized these procedures and processes 15 million claims annually. Average claim processing time is now ¼ the time it was prior to the USL implementation.

Is your state’s Health Care Services agency overwhelmed with the continual changes, volume and complexity of processing claims for Medicaid and other funding sources?
Does your system produce the federal CMS-64 report automatically?
Is producing payments a complex manual or spread sheet based process utilizing diverse and antiquated systems?
Can payments be produced at a summary level by program with “drill down” to the Claims Detail?
Can the different Federal Financial Participation (FFP) programs be applied automatically, without re-programming your software?
Are reimbursement invoices generated automatically reflecting FFP or other agency participation, and including automatically collated “backup” detailed reports?
Is importing Claims into the financial system automated?
Do you provide warrant/EFT payment information to the entities being paid at the claim level?
Are claims and reimbursements automatically journalized into the state financial system?
Does your software meet the latest ACA EFT requirements?


• Accelerate the reimbursement of Medicaid claims to the state’s counties or other entities
• Provide a consolidated series of reports for internal & external auditors and other stakeholders
• Reduced the time to process claims to three (3) weeks
• Eliminate manual processes substantially reducing staff effort
• Provide counties with on-line reimbursement status of claims

• Automate claims collection from counties or other state agencies, etc.
• County Claims e.g., Affordable Care Act, Children’s Services, Breast Cancer, Mental Health, etc.
• Social Services e.g., adoption, child welfare, healthy families, food, etc.
• Differentiate, classify, and validate claims according to type for Federal or State Participation (FFP, SGF) and/or other funding sources
• Based on claim type, source, aid codes, medical eligibility group, etc.
• Table-driven rules to allow insertion of new aid codes without costly software changes.
• User-defined medical eligibility groups and/or other classifications by program.
• Provide summary/detailed reports to adjudicate, validate, and track claims
• Automated rules-based filtering and categorization/detailed
• Workflow for claims processing
• Success/Failure metrics
• Claim level details with start/finish historical reporting
• Apportion claims based on pre-defined allocation rules
• By percent, multiple pools, contract rules, etc.
• Table based to accommodate change, e.g., federal aid codes
• Validate aid code percentages applied during adjudication
• Invoice and distribute claims to funding sources with full audit trail
• Electronically by EFT and/or wet sig-nature
• Specialized invoice by funding source with supporting/accompanying “backup” reports (MEG, FFP, etc.) automatically collated.
• Participation metrics captured for later federal/state stakeholder audit reporting.
• Track receipts from funding sources and reconcile claims
• Exceptions, adjustments, liquidations
• Invoice host (State or Agency) for non-participatory amounts
• AR Cash receipts automatically re-lease AP claim schedules for payment
• Disburse funds to original claimants
• Showing share of each participating funding source
• Report warrant/EFT used to pay claim schedule down to the service provider and detailed claim level

Download Medicaid Claims Cut Sheet

Produce Claim Schedules & Reports:
• At summary levels with drill down to detail claim
• By Funding Source, Program or Cate-gory
• Claim Schedule face sheet accompanied by supporting detail reports
Provide reports, analysis and audit trails:
• In PDF, Excel, etc.
• For claimants
• For Host Agency e.g., State Government, other agencies
• For Funding Sources e.g., Federal Government
• Statutory Reports e.g., CMS 64, other agencies/funds

Minimum System Requirements
• Dual Core, 2.3 GHz or better
• 4GB RAM (32-bit Windows Server) sized by need
• 8GB RAM (64-bit Windows Server) sized by need
• Windows Server 2008 – 2012 (R2 supported) (64-bit recommended)
• Microsoft SQL Server 2008 – 2014 (R2 supported) (64-bit recommended)
TERMINAL SERVER (if utilized):
• Dual Core, 2.3 GHz or better
• 4GB RAM (32-bit Windows Server) sized by user count
• 8GB RAM (64-bit Windows Server) sized by user count
• Windows Server 2008 – 2012 (R2 supported) (64-bit recommended)
• Core 2 Processor, 2.3 GHz or better
• 2GB RAM or better
• Microsoft Windows 7 (SP1) – Windows 10 Pro
• Microsoft Office Professional 2007 – 2016 (32-bit only)

Online Help
USL Financials contains context-sensitive, online help for all features and functions of the system.

• Full USL Database, Module, Menu, Function, Action and Account Lev-el security options relative to the system security.
• Full security by Delivery Location in PO and PQ.
• Departmental Security via Workgroups in A/P, A/R, GL, and PQ.
• Security by Project, Sub-Project, and Funding Source (Grant).
• Relative to system security, The AP module has special menu items for administrative processing. Supervisor can see all the data entry users entries and is able to post it.

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