REJECTED INVOICES AND CLAIMS

Rejected invoice?! How frustrating! Your vendor did the work, you submitted the invoice, and now they're waiting for payment, but the FMS can't process your invoice! What gives?!

FMS Pay estimates over 20% of invoices/claims we receive are rejected for lack of compliance. Yikes!

Did you know? The FMS can only pay for services adequately supported by the client's Regional Center spending-plan!

Because the Self-Determination Program (SDP) must follow strict government and Medicaid rules, invoices that are missing required Department of Developmental Services (DDS) elements, or that don't tie to the client's spending-plan will be rejected. Not only do rejected invoices create more work for your vendors and the FMS, but your vendors might need those funds to cover payroll!

SDP is a complex program, and mastering the billing requirements is a critical element of participant and vendor success in the program. While we cannot control the requirements of state and federal agencies, we can provide information to help your claims process more smoothly in alignment with those requirements, and reduce the risk your vendors have to repay their claims.

Did you know? In the event of an audit, invalid/unsupported vendor claims will be clawed back.

Many invoices are rejected for basic math and administrative sloppiness and errors. Common reject reasons include:

1. Miscalculations/basic math errors

2. Incorrect / typo'd dates

3. Missing vendor or client information

4. Received in an invalid format such as Word Doc, Google Link or JPG file. (invoices should only be in PDF format).

5. Lack of readability, improper text/data formatting. (Text cut off, covered up, poor scan quality, etc).

The next major reject reason is lack of required DDS invoice elements/Failure to follow the DDS invoice directive. Common reject reasons include:

1. Missing vendor/client name

2. Missing service codes

3. Inadequate descriptions of services

4. Failure to list each date of service

5. Missing Certification Statement and vendor signature

Accurate service coding is essential to verify provider qualifications, maintain federal waiver compliance, and protect clients’ rights to clinically appropriate, ethically delivered care by providers who meet the required standards for that level of intervention.

The final major reason for rejections are lack of a supporting spending-plan. Common reject reasons include:

1. Specific service/vendor not indicated in the client's spending-plan.

2. Rate of service different from spending-plan document

3. Service descriptions on vendor invoices don't align with agreed upon services in spending-plan (e.g. telling the Regional Center you are receiving "Massage Therapy" but then receiving an invoice for "Physical Therapy.")

So - How can you and your vendors prepare for a smooth claims process?

1. Carefully review the DDS invoice directive and related billing flowchart, and be sure to incorporate every single required element into your invoice.

2. Put strong effort into into creating a valid invoice from the start, so you aren't doing more work on the backend trying to fix a billing fiasco, or even worse, having to repay the state for invalid claims. (Make sure your math adds up, that your dates are accurate, etc.)

3. Ask questions and attend FMS Pay's ongoing virtual support sessions if you need support.

4. Kick your invoice back to your vendor if you spot an error, rather than waiting for the FMS to catch the error.

And remember... "A Good Invoice Gets A Good Payment."

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