Body of Report

40.2 - Body of Report (Rev. 175, Issued: 10-28-10, Effective: 04-01-11, Implementation: 04-04-11) For all PRO adjustments, determine the appropriate column. Complete the report for each line as follows: • Line 1 - Opening Pending - The intermediary enters the total number of adjustment request records reported as pending at the end of the previous month. • Line 2 - Revisions to Opening Pending - The intermediary reports the net result of the number of request records that should not have been counted as adjustment request records pending at the end of the previous month (minus) and the number that were not counted but which should have been (plus). • Line 3 - Revised Opening Pending - The intermediary enters line 1 plus line 2. • Line 4 - Electronic Adjustment Request Records Received - The intermediary enters the number of electronic adjustment request records received from the PRO in the month. • Line 5 - Electronic Adjustment Request Records Rejected - The intermediary enters the number of electronic adjustment request records reported on line 4 that failed contractor front end edits. • Line 6 - Electronic Adjustment Request Records Accepted - The intermediary enters the difference of line 4 minus line 5. • Line 7 - Hard Copy Adjustment Requests Received - The contractor shall enter the number of hard copy adjustment requests it received from its PRO(s). It shall count only hard copy requests the PRO has identified as 11P, 13P, 18P, 21P, or 83P. • Line 8 - Additional Bills to be Processed Due to Interim Bills-The intermediary enters the number of interim bills to be adjusted as a result of PRO electronic or hard adjustment requests. It does not count interim bills for which no change is needed. • Line 9 - Total Adjustment Bills to be Processed - The intermediary enters the total number of adjustment bills to be processed. This is the sum of lines 3, 6, 7, and 8. • Line 10 - Non-processable Adjustment Bills - Failed Batch/System Edits - The intermediary enters the number of bills it could not process due to batch/system edits. It includes any requests which conflict with its history; e.g., utilization. It counts any interim bill which edits out of its system. These bills will be identified as non-processable on the Revisions to the Monthly PRO Adjustment Bill Report. • Line 11 - Total Adjustment Bills Processed - The intermediary enters the total number of adjustment bills it has processed as a result of PRO adjustment requests (hard copy and electronic). It counts each bill when multiple bills are processed to satisfy one request. • Line 12 - Number Completed in 60 Days or Less - The intermediary enters the number of adjustment bills processed in 60 days or less from the date it received the adjustment request record. • Line 13 - Number Completed in 61-90 Days - The intermediary enters the number of adjustment bill processed in 61 to 90 days. • Line 14 - Number Completed in 91-120 Days - The intermediary enters the number of adjustment bills processed in 91 to 120 days. • Line 15 - Number Completed Over 120 Days - The intermediary enters the number of adjustment bills processed in 121 days or more. • Line 16 - Closing Pending - The intermediary enters the total number of adjustment request records pending at the end of the report month.