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Medicare Reimbursement System


SSI's ON-LINE Medicare Reimbursement Processing System is designed to provide the functional requirements needed of a Fund Administrator. The System will handle the process of verifying eligibility, producing reimbursement checks, maintaining data on eligible members and printing checks. In addition, the Reimbursement System provides for the printing of check registers, mailing labels, a verification list of members to be paid each period, reporting of year-to-date totals paid to each member and various statistical data for actuarial and management reporting.

The programs provided in SSI's Medicare Reimbursement Processing System perform the following functions:

1. TYPE CODE PROCESSING

This function is used to establish a coding structure which represents the different amounts of Medicare reimbursement that each eligible member can receive.

2. MEMBER ENTRY

This function allows for the entry of new eligible members. This function is integrated with SSI's enrollment system. The information maintained on each member for reimbursement purposes includes:

Member's social security number
Member's name
Effective date
End date
Medicare type code
Group Code

3. PRE-CHECK REGISTER

This function is used to display or make changes to the information maintained for each member, including payment information. This function also prints a verification list of members to be paid each period including:

Member's Social Security Number
Member's Name
Amount
Amount this period
Period Dates

4. CHECK WRITING

This function prints the checks for all Medicare reimbursement eligible members. In addition, it will automatically discontinue checks upon reaching the final end date. Checks can be printed in sequence determined by group code order.

5. CHECK REGISTER

This function prints a register of checks issued for the period.

6. MANUAL CHECK WRITING AND VOIDING

This function allows the ability to enter and make adjustments to payments made manually, (voids, replacement checks, additional payments, etc.)

7. PAYMENT HISTORY DISPLAY

The system allows display of complete payment history by member showing check date, check number or check amount. This screen will also reflect any manual checks issued or voids.

8. AGE CENSUS

This function prints a report which lists all members eligible for Medicare reimbursement and their respective ages to be used in conjunction with the actuarial projections.