2012-13
Colorado Immunization Program (CIP)
ACA RIZO Monthly Report

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RIZO Claim Information

Please enter all claim data for the most recent month. RIZO and school-located clinic data are to be entered together.  Do not enter cumulative data. Values entered should reflect a snapshot of activity that occurred in the last month only. Given the cycle time of claim processing, data entered for “# claims submitted” and “$ amount submitted” will not correlate to the “$ amount paid” column, as they do not likely reflect the same claims. 

When entering data, please itemize data by payer source, showing the claim details for admin fees separately from vaccine fees in the corresponding rows. If a specific payer does not itemize reimbursements for admin fee separately from vaccine, you may mark “Yes” in the field for combining admin and vaccine fees. In those cases only, all claim data should be entered in the admin row, with the vaccine row left blank. 

Special notes: If the dropdown menu is missing a payer source, please contact Jodi Maturo at 303-692-2753 to have it added.


1.  Medicaid
Medicaid
admin & vaccine
fee combined?
Medicaid
existing
contract?
 
 Medicaid
#
of claims
Medicaid
$
amount
submitted
Medicaid
$
amount
paid
Admin fees only:
Vaccine fees only:

2.  Medicare
Medicare
admin & vaccine
fee combined?
Medicare
existing
contract?
 
 Medicare
#
of claims
Medicare
$
amount
submitted
Medicare
$
amount
paid
Admin fees only:
Vaccine fees only:

3.  CHP+
CHP+
admin & vaccine
fee combined?
CHP+
existing
contract?
 
 CHP+
#
of claims
CHP+
$
amount
submitted
CHP+
$
amount
paid
Admin fees only:
Vaccine fees only:

4.  Rocky Mountain Health Plan
Rocky Mountain
Health Plan
admin & vaccine fee
combined?
Rocky Mountain
Health Plan
existing
contract?
 
 Rocky Mountain
Health Plan
#
of claims
Rocky Mountain
Health Plan
$
amount
submitted
Rocky mountain
Health Plan
$
amount
paid
Admin fees only:
Vaccine fees only:

5.  Anthem BC/BS
Anthem BC/BS
admin & vaccine
fee combined?
Anthem BC/BS
existing
contract?
 
 Anthem
BC/BS
#
of claims
Anthem
BC/BS
$
amount
submitted
Anthem
BC/BS
$
amount
paid
Admin fees only:
Vaccine fees only:

* Indicates Response Required