Aging Report In Excel Format 32320 | Claims Aging Report Smmc 04012017

Partial file snippet.

Sheet 1: Instructions

	
	
		INSTRUCTIONS FOR COMPLETING CLAIMS AGING TEMPLATE
	
	
		REPORT MMA AND LTC AS APPROPRIATE
	
	
		

	
	
		This template computes an aging claims analysis on a quarterly basis.  
	
	
		Basis for Reporting:  Report at the claim line level.
	
	
		Clean Claim = A claim that can be processed without obtaining additional information from the provider of the service or from a third party.  It does not include a claim from a provider who is under investigation for fraud, abuse, or a claim under review for medical necessity.
	
	
		For paid claims, the date of payment is the check date for payments issued by check.  For electronic payments (ACH or wire), the date of payment is the date the payment file (or similar file) is delivered to the financial institution.  For denied claims, the applicable date is the date of denial.
	
	
		

	
	
		The claims data should NOT be run for this report until at least 31 days after the end of the reporting quarter but before the due date for filing the report (45 days after the end of the reporting quarter).
	
	
		

	
	
		The claims data MUST be MEDICAID only.
	
	
		1. Cover Sheet - Input information for the plan's name, quarter ending, plan's 7 (seven) digit provider ID number, and the date the data was run for the quarterly report.
	
	
		2.  MMA - Enter ALL MMA claims with a received date that corresponds to the dates of the report quarter. The sheet is broken out by Electronic and Non-Electronic receipt of claims, as well as  total. 
	
	
		3.  LTC - Enter ALL LTC claims with a received date that corresponds to the dates of the report quarter. The sheet is broken out by Electronic and Non-Electronic receipt of claims, as well as  total. 
	
	
		** Only the Yellow cells are for input.  
	
	
		

	
	
		Type Codes:
	
	
		PRIMARY CARE = REPORT IN SUMMARY
	
	
		SPECIALTY = REPORT IN SUMMARY
	
	
		OTHER = REPORT IN SUMMARY
	
	
		HOSPITAL = REPORT IN SUMMARY
	
	
		NURSING FACILITY/HOSPICE = REPORT IN SUMMARY
	
	
		

	
	
		For questions or assistance with this report, please contact your plan's Contract Manager.
	
	
		File the template in its entirety to the Agency via the SMMC SFTP site by the due date (45 days after the end of the reporting quarter). 
	



Sheet 2: Cover Sheet

	
	
	
	
	
		Medicaid Claims Aging Report
		
	
		

		

		

		

	
	
		

		

		

		

	
	
		

		

	
	
		Plan Name:
		

		

	
	
		

		

		SMMC MMA
		

	
	
		Contact Person:
		

		SMMC LTC
		

	
	
		Telephone:
		

		

		

	
	
		E-Mail:
		

		

		

	
	
		Fax:
		

		

		

	
	
		

		

		

		

	
	
		

		

		

		

	
	
		

		

		

		

	
	
		

		 For the quarter ending: 
		

		

	
	
		

		**Quarterly Report Data Run Date: 
		

		

	
	
		

		7-Digit Base Provider ID#: 
		

		

	
	
		

		

		

		

	
	
		

		

		

		

	
	
		Comments/Notes:
		

		

	
	
		

		

	
	
		

		

	
	
		

		

	
	
		

		

	
	
		

		

	
	
		

		

	



Sheet 3: MMA

	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
		Plan Name
		

		

		

		

		

		

		

		

		

		MANAGED MEDICAL ASSISTANCE (MMA)
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Quarter Ending
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		ELECTRONICALLY SUBMITTED CLAIMS
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		ELECTRONIC CLAIMS PAID/DENIED WITHIN 7 CALENDAR DAYS
		ELECTRONIC CLAIMS PAID/DENIED WITHIN 10 CALENDAR DAYS
		ELECTRONIC CLAIMS PAID/DENIED WITHIN 20 CALENDAR DAYS
		

		ELECTRONIC CLAIMS PAID/DENIED WITHIN 90 CALENDAR DAYS
		
	
		Provider
		NO. OF CLAIMS PROCESSED
		CLAIMS PAID WITHIN 7 CALENDAR DAYS
		%
		CLAIMS DENIED WITHIN 7 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 7 CALENDAR DAYS
		%
		CLAIMS PAID WITHIN      8-10 CALENDAR DAYS
		

		CLAIMS DENIED WITHIN      8-10 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 8-10 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 10 DAYS
		%
		CLAIMS PAID WITHIN      11-20 CALENDAR DAYS
		

		CLAIMS DENIED WITHIN      11-20 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 11-20 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 20 DAYS
		%
		

		TOTAL CLAIMS PROCESSED WITHIN 90 DAYS
		%
	
	
		Primary Care
		

		

		0%
		

		0%
		0
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		

		0%
	
	
		Specialty
		

		

		0%
		

		0%
		0
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		

		0%
	
	
		Hospital
		

		

		0%
		

		0%
		0
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		

		0%
	
	
		Other
		

		

		0%
		

		0%
		0
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		

		0%
	
	
		Total
		0 
		0 
		0%
		0
		0%
		0
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		

		0 
		0%
	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		NON-ELECTRONICALLY SUBMITTED CLAIMS
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 7 CALENDAR DAYS
		NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 10 CALENDAR DAYS
		NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 20 CALENDAR DAYS
		

		NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 120 CALENDAR DAYS
		
	
		Provider
		NO. OF CLAIMS PROCESSED
		CLAIMS PAID WITHIN 7 CALENDAR DAYS
		%
		CLAIMS DENIED WITHIN 7 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 7 CALENDAR DAYS
		%
		CLAIMS PAID WITHIN      8-10 CALENDAR DAYS
		

		CLAIMS DENIED WITHIN      8-10 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 8-10 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 10 DAYS
		%
		CLAIMS PAID WITHIN      11-20 CALENDAR DAYS
		

		CLAIMS DENIED WITHIN      11-20 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 11-20 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 20 DAYS
		%
		

		TOTAL CLAIMS PROCESSED WITHIN 120 DAYS
		%
	
	
		Primary Care
		

		

		0%
		

		0%
		0
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		

		0%
	
	
		Specialty
		

		

		0%
		

		0%
		0
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		

		0%
	
	
		Hospital
		

		

		0%
		

		0%
		0
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		

		0%
	
	
		Other
		

		

		0%
		

		0%
		0
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		0%
		

		0%
		0 
		0%
		0 
		0%
		

		

		0%
	
	
		Total
		0 
		0 
		0%
		0
		0%
		0
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		

		0 
		0%
	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		TOTAL CLAIMS RECEIVED
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		TOTAL CLAIMS PAID/DENIED WITHIN 7 CALENDAR DAYS
		TOTAL CLAIMS PAID/DENIED WITHIN 10 CALENDAR DAYS
		TOTAL CLAIMS PAID/DENIED WITHIN 20 CALENDAR DAYS
		

		

		

	
	
		Provider
		NO. OF CLAIMS PROCESSED
		CLAIMS PAID WITHIN 7 CALENDAR DAYS
		%
		CLAIMS DENIED WITHIN 7 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 7 CALENDAR DAYS
		%
		CLAIMS PAID WITHIN      8-10 CALENDAR DAYS
		

		CLAIMS DENIED WITHIN      8-10 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 8-10 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 10 DAYS
		%
		CLAIMS PAID WITHIN      11-20 CALENDAR DAYS
		

		CLAIMS DENIED WITHIN      11-20 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 11-20 CALENDAR DAYS
		%
		TOTAL CLAIMS PROCESSED WITHIN 20 DAYS
		%
		

		

		

	
	
		Primary Care
		0 
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		

		

		

	
	
		Specialty
		0 
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		

		

		

	
	
		Hospital
		0 
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		

		

		

	
	
		Other
		0 
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		

		

		

	
	
		Total
		0 
		0 
		0%
		0
		0%
		0
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%
		0 
		0%

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...Sheet instructions for completing claims aging template report mma and ltc as appropriate this computes an analysis on a quarterly basis reporting at the claim line level clean that can be processed without obtaining additional information from provider of service or third party it does not include who is under investigation fraud abuse review medical necessity paid date payment check payments issued by electronic ach wire file similar delivered to financial institution denied applicable denial data should run until least days after end quarter but before due filing must medicaid only cover input plan s name ending seven digit id number was enter all with received corresponds dates broken out nonelectronic receipt well total yellow cells are type codes primary care in summary specialty other hospital nursing facilityhospice questions assistance please contact your contract manager its entirety agency via smmc sftp site person telephone email fax base commentsnotes managed electronicall...

Medicaid Claims Aging Report



Plan Name:
		SMMC MMA
Contact Person:		SMMC LTC
Telephone:
E-Mail:
Fax:



	For the quarter ending:
	**Quarterly Report Data Run Date:
	7-Digit Base Provider ID#:


Comments/Notes:

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Plan Name										MANAGED MEDICAL ASSISTANCE (MMA)
Quarter Ending


ELECTRONICALLY SUBMITTED CLAIMS

		ELECTRONIC CLAIMS PAID/DENIED WITHIN 7 CALENDAR DAYS						ELECTRONIC CLAIMS PAID/DENIED WITHIN 10 CALENDAR DAYS								ELECTRONIC CLAIMS PAID/DENIED WITHIN 20 CALENDAR DAYS								ELECTRONIC CLAIMS PAID/DENIED WITHIN 90 CALENDAR DAYS
Provider	NO. OF CLAIMS PROCESSED	CLAIMS PAID WITHIN 7 CALENDAR DAYS	%	CLAIMS DENIED WITHIN 7 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 7 CALENDAR DAYS	%	CLAIMS PAID WITHIN 8-10 CALENDAR DAYS		CLAIMS DENIED WITHIN 8-10 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 8-10 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 10 DAYS	%	CLAIMS PAID WITHIN 11-20 CALENDAR DAYS		CLAIMS DENIED WITHIN 11-20 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 11-20 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 20 DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 90 DAYS	%
Primary Care			0%		0%	0	0%		0%		0%	0	0%	0	0%		0%		0%	0	0%	0	0%		0%
Specialty			0%		0%	0	0%		0%		0%	0	0%	0	0%		0%		0%	0	0%	0	0%		0%
Hospital			0%		0%	0	0%		0%		0%	0	0%	0	0%		0%		0%	0	0%	0	0%		0%
Other			0%		0%	0	0%		0%		0%	0	0%	0	0%		0%		0%	0	0%	0	0%		0%
Total	0	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%

NON-ELECTRONICALLY SUBMITTED CLAIMS

		NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 7 CALENDAR DAYS						NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 10 CALENDAR DAYS								NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 20 CALENDAR DAYS								NON-ELECTRONIC CLAIMS PAID/DENIED WITHIN 120 CALENDAR DAYS
Provider	NO. OF CLAIMS PROCESSED	CLAIMS PAID WITHIN 7 CALENDAR DAYS	%	CLAIMS DENIED WITHIN 7 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 7 CALENDAR DAYS	%	CLAIMS PAID WITHIN 8-10 CALENDAR DAYS		CLAIMS DENIED WITHIN 8-10 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 8-10 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 10 DAYS	%	CLAIMS PAID WITHIN 11-20 CALENDAR DAYS		CLAIMS DENIED WITHIN 11-20 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 11-20 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 20 DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 120 DAYS	%
Primary Care			0%		0%	0	0%		0%		0%	0	0%	0	0%		0%		0%	0	0%	0	0%		0%
Specialty			0%		0%	0	0%		0%		0%	0	0%	0	0%		0%		0%	0	0%	0	0%		0%
Hospital			0%		0%	0	0%		0%		0%	0	0%	0	0%		0%		0%	0	0%	0	0%		0%
Other			0%		0%	0	0%		0%		0%	0	0%	0	0%		0%		0%	0	0%	0	0%		0%
Total	0	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%

TOTAL CLAIMS RECEIVED

		TOTAL CLAIMS PAID/DENIED WITHIN 7 CALENDAR DAYS						TOTAL CLAIMS PAID/DENIED WITHIN 10 CALENDAR DAYS								TOTAL CLAIMS PAID/DENIED WITHIN 20 CALENDAR DAYS
Provider	NO. OF CLAIMS PROCESSED	CLAIMS PAID WITHIN 7 CALENDAR DAYS	%	CLAIMS DENIED WITHIN 7 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 7 CALENDAR DAYS	%	CLAIMS PAID WITHIN 8-10 CALENDAR DAYS		CLAIMS DENIED WITHIN 8-10 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 8-10 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 10 DAYS	%	CLAIMS PAID WITHIN 11-20 CALENDAR DAYS		CLAIMS DENIED WITHIN 11-20 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 11-20 CALENDAR DAYS	%	TOTAL CLAIMS PROCESSED WITHIN 20 DAYS	%
Primary Care	0	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%
Specialty	0	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%
Hospital	0	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%
Other	0	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%
Total	0	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%	0	0%

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