Page 607

580

provider the correct service month or return the submission unpaid to be corrected and re-submitted by the provider. Providers may submit more than one (1) Request for Payment CC78 form at the same time due to a submission being returned for corrections, therefore each submission must have the service month identified. When a submission is multiple pages and the service month is included on the first (1st) page, the provider may be contacted for clarification if the additional pages are for the same month. 3. Facility/Provider’s Name and or ICCISNumber When a provider’s Request for Payment CC78 form does not include the facility/provider’s name and or their ICCIS number the CCPO Accounting Staff must research the children included on the submission to obtain the provider’s name. The CCPO Accounting Staff must contact the provider to confirm the submission is theirs and advise both the name and ICCIS number were left off the form. The correct information will be added with verbal guidance from the provider, and the submission processed. If the submission does not include the facility/provider’s name but does include their ICCIS number or vice versa it is acceptable.

4. Child’s and Parent’s Name The Request for Payment CC78 form is to reflect each child’s first and last name, as shown on the Child Care Assistance Authorization document, for those children for whom payment is being requested who actually attended or who did not attend during the required ten (10) business day notice period during the service month.

When an entry is missing, misspelled, or abbreviated in some way and a logical connection can be made through review of ICCIS, the entry is corrected, initialed, and dated. Nicknames or different names used by the provider for the child are not acceptable. If a reasonable connection cannot be made, the CCPO Accounting Staff will attempt to contact the provider to obtain the correct information and document the attempt in an ICCIS case note. If unable to contact the provider, the Request for Payment CC78 is returned unpaid. The CCPO Accounting Staff will issue a Child Care Assistance Provider Request for Payment Returned -Unpaid Notice identifying the need for clarifying information. The action is case noted using the subject heading: MM/YYYY CCA-Request for Pay Returned Unpaid. The body of the case note includes explanation regarding why the Request for Payment CC78 is being returned