Medicaid Payment Reconciliation

The Medicaid Payment Reconciliation System (MPR) from APPX Software, Inc is used to reconcile Medicaid Client payment information available to State of Florida Counties.

Each county in Florida is required to repay a portion of the Medicaid costs of eligible recipients that are living in a nursing home or receive hospital care. The State of Florida provides a listing (bill) for the clients the county may be liable for and the county’s share for each of those clients. The State also provides access to this data electronically via a downloadable file.

While the State verifies each client’s last known address, it remains the County’s responsibility to verify the eligibility of each client and to make sure the client is a resident of that county.

Manually reconciling the information the State sends each month can take hours to weeks depending on the volume of transactions. That’s where the MPR system can help. The billing information your county receives is also available through the Internet as a download file. By using that file the MPR system can help you save time and money.

The system helps reduce processing time by eliminating over-payments and increasing your efficiency, accuracy, and productivity. How? Processing time is saved by letting MPR do the work for you. It’s estimated that 90% of the transactions are for clients that reside in nursing homes. Each month you have to verify the address for each of these clients to ensure they are county residents.

With the MPR system you add a Residency once, set an eligibility flag, and let the MPR system verify the addresses. The 90% that are okay will go through each month without any intervention.

You maintain complete control. If a client moves or otherwise becomes ineligible, simply change their eligibility flag and no payments will go through without your approval.

With hundreds of clients to review each month, it is easy to miss errors. You may approve a payment for a client that is not from your county, or you may pay for the same service period more than once. Letting MPR validate each request for payment guarantees that you will not accidentally pay for a client you have not verified.

The MPR system will look for duplicate payments. As each month is processed, a history file is updated with all the payments, whether approved or denied. All new requests are matched against this history file to ensure you do not pay twice for the same service period.

In 2011, release 4.0 of MPR was delivered. This release was developed to address a number of customer enhancement requests. Features include:
• Tabbed Menu system to simplify navigation.
• Larger application screen size to see more detail.
• Redesigned residency and reconciliation screens to simplify entry.
• Summary letter and reports created in PDF output to present a finished look, including your logo. PDF also allows emailing or archiving the reports from your desktop.
• Ability to assign denial codes on COR based on eligibility code.
• Verify Per Diem Report improves per diem processing.
• Payment Analysis per Date Range Report shows payment history within user defined date range.
• Reconciliation Recap Report shows current cycle totals prior to running post (trial balance).
• Wiki manual with onscreen links
• Simplified steps to import and export billing file.

To find out more about Appx, please go to our web site,, or call us at (800) TRY-APPX, (879-2779).