CP4
Calculation and Resolution
CMS-required outcome
The system correctly calculates payable amounts in accordance with the State Plan and logs accounts payable amounts for payment processing. The system accepts, adjusts, or denies claim line items and amounts and captures the applicable reason codes.
Default metrics
- Count/percentage of transactions by reason code.
- Count/percentage of transactions re-priced post-payment by underpayment/ overpayment and, if applicable, reason code or other applicable categorization available to the State.
Regulatory sources
- 42 CFR 431.052(published as 431.052; resolves to 431.52)