When I call the Interactive Voice Response (IVR) system and select option #2 (Payment Information), then option #1 (Payment Floor Information), the IVR states that I have 256 claims on the payment floor for $10,652.10. Where do those numbers come from and what is the payment floor?

The payment floor establishes a waiting period during which time the contractor may not pay, issue, mail, or otherwise finalize the initial determination on a clean claim. Claims on the payment floor are in the waiting period for payments to be released. The dollar amount given by the IVR for payment floor claims is the total amount of allowed charges for those claims that have had a claim determination made on them but still in the waiting period for payment to be issued.

It is possible for the number of claims on the payment floor and dollar amount for those claims to change each day as new claims are submitted, a claim determination made which adds those claims to the payment floor while other claims complete through for payment and are removed from the payment floor.

The payment floor date is determined by counting the number of days since the day the claim was received, i.e., the count begins the day after the day of receipt.

There are different waiting periods, and thus different payment floor dates, for electronic claims and paper claims. The waiting periods are 13 days for electronic claims and 26 days for paper claims. The payment floor represents the earliest date contractors may release payment for a completed clean claim. 

Reference: Publication 100-04, Chapter 1, Section (PDF, 1.63 MB).

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