The PRSI Claims Report can be used to reconcile claims once a payment schedule is received from Welfare Partners. Claims can be reconciled in bulk, or individually.
Here are some tips for how to reconcile claims:
The PRSI Claims report can be filtered by the following options in order to best match the list to the Schedule of payments received from Welfare Partners:
Filter by:
Claim Submission date - for the date range of the claims being returned.
Practitioner - for the panel number of the claims being returned.
Status - Setting the status to 'Raised' will return just the claims requiring reconciliation
Example:
Marking Claims as Settled:
Marking claims as Settled or otherwise, requires the Status of the claim to be set.
Marking Claims in Bulk
Claims can be updated in bulk, or individually. Where claims are all to be marked as settled and the Requested fee matches the Received Fee, it's easier to do this in bulk. All claims can be selected and updated with the appropriate details.
Claims to be updated can be selected using the tick box on the left of each claim, select individual claims, or an entire page if appropriate using the tick box at the top of the list:
Once the appropriate claims are selected, use the 'Update XX Claims' button at the top right of the report (XX will be the number of claims you have selected).
The Bulk Update Screen:
Select the status you would like to apply to the selected claims.
Once the claims have been selected and the Bulk Update option chosen, the status of the claims should be set to 'Settled'. The Fee Received will automatically be set to match the Fee Requested.
Note: If you are marking claims as Settled or Queried and the Fee Received does not match the Fee Requested, then the correct procedure would be to mark the claims individually, so the actual fee received can be entered.
Once a status other than Raised has been selected, you can then choose to update any of the other options.
Payment Date: The date that payment was received by PRSI. (Note: The Reconciled date will be set to the date this action was taken)
Tax Reference number: This is optional. If a Tax Reference was received with the payment, this can be added to the claim to help report on all claims paid in a single Payment Schedule.
Other Bulk Updates:
Claims selected in bulk can be updated to reflect other changes. The statuses can be set to any of the available options, but remember, the changes you make will be applied to all of the selected claims.
Marking Claims Individually
Where claims are Settled, or change status in any other way individually, using the Bulk Updating option is not always appropriate.
For Example: Where a claim is Queried or Settled, but the Fee Received does not match the Fee Requested, the actual fee awarded may be specific to a particular claim.
Hover over the claim in the PRSI Claims Report and use the Pencil icon to update the claim.
When updating single claims, the Status, Comments, Payment date and Tax Reference number can be edited in the same as the multi claim update screen.
In addition, the Fee Received for individual claims can be updated where these differ from the Fee Requested.
Marking Claims as Queried or Rejected:
Once the claims to be updated have been selected, select the appropriate status.
Status Comment: Where a claim was not successful, a set list of comment types can be added to the claim, indicating any further action that is required. The PRSI Claims report can be filtered to show claims with each type of comment attached.
A status of Queried would indicate that the claim request was not fully successful but that further action is required. Setting this status and adding Status Comments will help to audit the PRSI claims and to find the claims which still require action.
A status of Rejected would indicate claims that will not be reimbursed by PRSI. Status comments will help here to indicate the reason.
If a claim has not been fully reimbursed under PRSI, but no further contest is to be made, then the claim status should be set to Settled and the Fee Received should be set to indicate the amount received under PRSI.