Refund Number
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Refund Number assigned by MedSuite
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Issued To
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Type of person/entity the Refund is to be issued to:
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Issued To Name
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Select the Search button to select the person or entity to whom the Refund is being issued. This is a required field.
The Issue To Name may be "keyed-in" if the Issued To (Type) above is "Plan" or "Other". Otherwise, the user must select the Issue To Name from the Account, Patient, or Subscriber Search.
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For Patient
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When "Issued To" is a Patient, the "For Patient" field will default to the Patient selected in the "Issued To Name" field. When "Issued To" is an Account, the "For Patient" field will default to the Account Holder selected in the "Issued to Name" field if there is only one patient for that account holder. If there is more than one patient for that account holder, a drop down box appears on the "For Patient" field with all available Patients listed for that Account Holder. When "Issued To" is a Subscriber the system works the same as the Account. When Plan or Other are selected, select the "For Patient" Search button to select the patient for whom the Refund is being issued.
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Address
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Address consisting of:
This is a required field.
The tab order will skip from Street Address (Add'l) to the Postal Code. The Postal Code lookup will complete the City and State. In addition, the Postal Code lookup will default the Area Code of the telephone numbers if the Area Code is defined in Postal Code Maintenance
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Country
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A foreign country may be entered if needed.
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Phone
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Phone number of person/entity the Refund is to be issued to.
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Phone Work
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Work phone number of person/entity the Refund is to be issued to.
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Amount
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Request refund amount. This is a required field.
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Division
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Enter/Select the Division for which the Refund is being issued
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Note
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Note to appear on refund check
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Status
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Status of the Refund:
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Date Request
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Date the Refund was requested
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Date Issued
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Date the Refund was set to issued status by the issuer.
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Date Paid
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Date the Refund Check was printed.
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Date Revoked
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Date the Refund was revoked or check was voided.
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