What happens when a provider goes over their authorized hours?
If a provider tries to claim more hours in OR PTC DCI than they are authorized to work for a given consumer in a pay period, they will receive an alert with the Authorization Remaining Balance error and the entry will be rejected, which will require additional steps from the provider to resolve and be paid accurately and timely.
How to prevent entries from being rejected due to this error?
To prevent entries from being rejected due to this error, the provider should track the Remaining Balance and ensure they are not claiming more than their Remaining Balance. Even one minute over their authorized hours will result in this error. They can see their Remaining Balance upon clock in for real-time or upon creating your historical entry (shown below). They can also view their Remaining Balance at any time on the web portal via the Authorizations Widget. See below for the steps needed to resubmit for each entry method type.
What does the Authorization Remaining Balance error look like on the mobile app and how to fix it?
- At the time of clock out, the provider will select Continue Clock Out, complete clock out verification, and check the attestation statement (Time is correct. Falsifying may be Medicaid fraud).
- Upon selecting Confirm Clock Out, an alert will pop up which reads, "Your punch has one or more violations and cannot be saved. Please review the violations below and select Cancel to make edits or cancel the entry.” The alert will show Authorization Remaining Balance under the Business Rule Name, which is telling you that you are over your authorized hours for the pay period. Below this will be a button reading Cancel. The provider must select Cancel.
- Upon selecting Cancel, a second alert will pop up which reads "The entry id [insert entry id] has been rejected." Below this alert will be a button reading Confirm. The provider must select Confirm.
- Selecting confirm will take the provider back to their dashboard. The entry will then be in a rejected status. The provider will not be paid for this rejected entry. The provider must create a historical time entry, with the reason code of Provider-other, that does not exceed their authorized hours.
What does the Authorization Remaining Balance error look like on the landline and how to fix it?
- At the time of clock out, the provider will follow the same process as normal. This includes entering the last four of the SSN, entering their PIN, and selecting yes for the attestation statement (Time is correct. Falsifying may be Medicaid fraud).
- After selecting 1 (one) for Yes to confirm the attestation statement, the provider will hear, “This punch will be rejected, as there are not enough units or dollars available on the authorization to support this punch. Please contact your supervisor. Thank you for calling the Oregon Provider Time Capture system. Goodbye.” The system will then disconnect the call. The entry will be in a rejected status and will not be paid. The provider will need to create a historical entry that does not exceed the authorized hours to claim their time.
What does the Authorization Remaining Balance error look like on the web portal and how to fix it?
After entering all entry information where the number of hours entered is greater than the Remaining Balance, the provider selects Save. Upon selecting Save, an Alert will pop up which reads, “Your punch has one or more violations and cannot be saved. Please review the violations below and select Return to make edits or cancel the entry.” Below the Alert, the business rule violation name(s) are listed. This will list Authorization Remaining Balance. Selecting Return will return you to the Add New Entry screen where you can edit the clock in and out times to make this entry be within the authorized hours.
What to do if this error appears while making a real-time entry and how to fix it?
If the provider sees the Authorization Remaining Balance error while making a real-time entry, they will need to create a historical entry, with the reason code of Provider-other, that does not go over their remaining balance. Remaining Balance means the number of hours out of their total authorized hours they have not claimed. On the web portal this is called the Available Balance.
To find out the Available Balance on the web portal:
- After the provider logs into the web portal, they will be on their home page or dashboard. Scroll down to see Authorizations in the middle of the page. This is called the Authorizations Widget.
- Begin typing the consumer’s name in the Type Client Name field. Once 3 or more characters have been typed, a drop-down list will appear. Select the consumer’s name from the drop-down.
- Select the Date of Service field. From the calendar, select a date within the pay period in question. For example, if the provider wants to know what their Remaining Balance is for the current pay period, enter today’s date.
- Select Search.
- All authorizations for this consumer and pay period will appear. The Service Code shows whether it is for hours or miles.
- The Current Available Balance for this period is listed to the right of Pre-Authorizations Holds.
To find out the Remaining Balance on the mobile app:
- Before selecting Confirm Clock In, the provider will see a clock in summary under the blue button. This summary lists the Client Name (consumer), Service Code, and Auth Remaining Balance. The item titled Auth Remaining Balance is the Remaining Balance the provider has for this consumer for the current pay period.
To find out the Remaining Balance on the landline for real-time entries:
- During clock in, after confirming the consumer, selecting real-time punch, and selecting the proper service code, the system will read the available number of hours for the current pay period.
What to do if this error occurs while making a historical time entry and how to fix it?
If the provider receives the Authorization Remaining Balance error while making a historical time entry, they will need to edit the number of hours they are claiming to be within their Remaining Balance.
To find out their Remaining Balance of hours on the web portal:
- Use the Authorizations Widget as described above.
- After selecting Add Entry on the dashboard and entering the consumer’s name and service date, the Remaining Balance field will populate. The provider is not able to claim more hours than what is listed here. This field is highlighted in the screenshot to the right.
To find out the Remaining Balance on a historical landline entry:
- After confirming the consumer, selecting historical punch, and selecting the proper service code, the system will read the available number of hours for the pay period.