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The Missouri CD 147 form, officially known as the Child Care Provider Payment Resolution Request, serves as a vital tool for child care providers facing payment discrepancies. This form allows providers to formally request a review of their payments when issues arise, ensuring that their concerns are addressed in a structured manner. To initiate the review process, providers must complete the form and submit it within 60 days following the end of the relevant service month. Additionally, it is required when submitting regular invoices that are 60 days overdue, necessitating an explanation for the delay in the "Explanation" section. Essential to this process is the inclusion of attendance records for each child and service month in question. The form collects key information such as the provider's contact details, the child's name, date of birth, and specific reasons for the payment review. While submitting the form does not guarantee payment, it is a necessary step toward resolving payment issues. Providers must return the completed form along with the required documentation to the appropriate Child Care Provider Relations Unit for processing.
Missouri Cd 147 Preview
MISSOURI DEPARTMENT OF SOCIAL SERVICES
CHILD CARE PROVIDER PAYMENT RESOLUTION REQUEST
The payment resolution process is a formal process for child care providers to have their child care payments reviewed when discrepancies occur. To initiate the review, this form must be completed by the child care provider and must be submitted within 60 days of the end of the service month in question. This form must also be used when a child care provider is submitting any regular invoices 60 days past the service month or 60 days past the "Return by" date found on the paper invoice, whichever is later. A statement must be included in the "Explanation" section below explaining why the invoices are being submitted late.
The attendance records for each child and service month listed below must be submitted with this form.
CHILD CARE PROVIDER/FACILITY
CONTACT NAME
DVN
TELEPHONE NUMBER
MAILING ADDRESS
CITY
STATE
ZIP CODE
The information provided below, along with complete attendance records, will be used to review payments for child care services provided. Your request will be reviewed and you will be notified of the outcome. Submission of this form does not guarantee payment.
CHILD'S NAME |
DATE OF BIRTH |
DCN |
SERVICE |
REASON FOR |
|
MONTH/YEAR |
REVIEW* |
||||
|
|
|
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
*In the Reason for Review column, enter the letter that best describes the situation: A. This child was not on my invoice.
B. The rates on my invoice were incorrect.
C. I provided more units of care than the child was authorized.
D. I was not paid for the units I submitted on my invoice. E. Other – Explain in space below.
EXPLANATION (attach additional pages if necessary)
Return the Child Care Provider Payment Resolution Request, along with attendance records for the child(ren)/month(s) in question, to the CHILD CARE PROVIDER RELATIONS UNIT responsible for processing your payments. NOTE: The address you choose in the drop down menu will be the address you send your invoices to.
DSS – CHILD CARE PROVIDER RELATIONS UNIT
LINC, 3100 BROADWAY STE 1100, KANSAS CITY MO 64111
PROVIDER SIGNATURE
DATE
CHILD CARE PROVIDER PAYMENT RESOLUTION REQUEST
PURPOSE:
The Child Care Provider Payment Resolution Request is the form providers are required to submit when payments need to be reviewed for discrepancies. Submitting the Child Care Provider Payment Resolution Request will initiate the process for payments to be reviewed for discrepancies.
INSTRUCTIONS:
This form may be typed or legibly handwritten by the child care provider or a representative of the child care provider.
To be eligible for review, all Child Care Provider Payment Resolution Request forms must be submitted with complete attendance records for each child and service month in question.
CHILD CARE PROVIDER/FACILITY - Enter the child care facility name or the child care provider's name.
CONTACT NAME - Enter the name of the person that can be contacted for any questions pertaining to the resolution request.
DVN - Enter the Departmental Vendor Number (DVN) for the facility or the provider.
TELEPHONE NUMBER - Enter the telephone number of the contact name.
MAILING ADDRESS - Enter the mailing address of the facility or individual child care provider.
CITY - Enter the city for the mailing address of the facility or individual child care provider.
STATE - Enter the state for the mailing address of the facility or individual child care provider.
ZIP CODE - Enter the zip code for the mailing address of the facility or individual child care provider.
CHILD'S NAME - Enter the child's name for which payment review is being requested. Each form allows up to ten children to be listed for payment review.
DATE OF BIRTH - Enter the child's date of birth for which payment review is being requested.
DCN - Enter the child's DCN for which payment review is being requested. A dcn will need to be entered for each individual child listed.
SERVICE MONTH/YEAR - Enter the service month and year for which payment review is being requested.
REASON FOR REVIEW - Enter the letter (A – E) corresponding to the reason for the review request. (The different reasons are listed below the child's name listing 1 – 10.)
EXPLANATION - Enter any information that may support the request for review.
RETURN THE CHILD CARE PROVIDER PAYMENT REQUEST
Go to the drop down box beside the DSS – Child Care Provider Relations Unit and select the address of the Provider Relations Unit responsible for processing your payments. The address you select in the drop down menu should be the address you send your invoices to.
OAddresses you can choose from to send your payment resolution request to:
PO Box 88, Jefferson City, MO,
LINC, 3100 Broadway, Ste 1100, Kansas City, MO, 64111
4411 N Newstead Ave, 3rd Fl, St. Louis, MO, 63115
PROVIDER SIGNATURE - You must sign the request and keep a copy for your records.
DATE
Enter the date of the request.
Once the Child Care Provider Payment Resolution Request has been completed in full, the provider will attach the appropriate attendance record(s) and mail the request to the DSS – Child Care Provider Relations Unit with the address selected from the drop down menu. Provider must keep a copy of the requests and attendance records for their records. Attendance records will not be returned.
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Dos and Don'ts
When filling out the Missouri CD 147 form, consider the following:
- Do complete the form within 60 days of the service month in question.
- Do provide a clear explanation for any late invoices in the "Explanation" section.
- Do ensure that all required attendance records are attached to the form.
- Do enter accurate information for each child, including their name and date of birth.
- Don't forget to sign the form before submission.
- Don't submit the form without checking for completeness and accuracy.
Key takeaways
1. Timeliness is crucial. The Missouri CD 147 form must be submitted within 60 days following the end of the service month in question. Late submissions may not be reviewed.
2. Complete attendance records are necessary. Each request for payment resolution must include thorough attendance records for every child and service month listed. Incomplete submissions may lead to delays or denials.
3. Clearly state the reason for review. In the designated section, indicate the reason for the payment discrepancy using the appropriate letter (A-E). This helps streamline the review process.
4. Include a detailed explanation for late submissions. If invoices are submitted later than the specified time frames, a clear explanation must be provided in the "Explanation" section. This is essential for the review to be considered.
5. Keep copies of all documents. After submitting the form and attendance records, retain copies for your own records. The submitted documents will not be returned, and having your own copies can be vital for future reference.
Misconceptions
Understanding the Missouri CD 147 form is essential for child care providers seeking payment resolution. However, several misconceptions can lead to confusion. Here are eight common misunderstandings about this important document:
- Misconception 1: The CD 147 form guarantees payment.
- Misconception 2: Attendance records are optional.
- Misconception 3: There is no deadline for submission.
- Misconception 4: The form can be filled out by anyone.
- Misconception 5: Only one child can be listed on the form.
- Misconception 6: The explanation section is not important.
- Misconception 7: The mailing address is irrelevant.
- Misconception 8: Keeping a copy of the form is unnecessary.
Many providers believe that submitting this form will automatically result in payment. In reality, submission initiates a review process, but does not ensure payment will be issued.
Some providers think they can skip submitting attendance records. However, complete attendance records are mandatory for the review process.
Providers may assume they can submit the form at any time. In fact, it must be submitted within 60 days of the service month in question.
While a representative can assist, the child care provider must complete the form to ensure accuracy and accountability.
Providers often think they can only request a review for one child. The form allows for up to ten children to be included in a single request.
Some providers underestimate the significance of the explanation section. Providing a clear rationale can greatly support the review process.
Providers might overlook the importance of selecting the correct mailing address. The address chosen determines where the payment resolution request will be sent and processed.
Many providers fail to keep a copy of their submission. Retaining a copy is crucial for future reference and to track the status of the request.
Clearing up these misconceptions can help child care providers navigate the payment resolution process more effectively. Awareness and understanding of the CD 147 form are vital to ensuring that providers receive the payments they are owed.
Similar forms
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Invoice Dispute Form: Similar to the Missouri Cd 147 form, the Invoice Dispute Form allows providers to formally request a review of discrepancies related to payments. It requires detailed information about the disputed invoice and supporting documentation, ensuring that all relevant data is submitted for a thorough review.
Cease and Desist Letter Request: To formally address unwanted behaviors or practices, you can utilize the Cease and Desist Letter form to initiate the necessary actions and documentation.
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Payment Adjustment Request: This document serves a purpose akin to the Missouri Cd 147 form by enabling providers to request adjustments to payments due to errors or omissions. It requires a clear explanation of the reason for the adjustment and often necessitates the inclusion of supporting records.
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Claim for Unpaid Services: Like the Missouri Cd 147 form, this claim allows providers to report unpaid services rendered. It requires a detailed account of the services provided, the relevant dates, and any supporting documentation to facilitate the review process.
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Child Care Subsidy Application: This application is similar in that it collects essential information about the child care provider and the services offered. It also requires documentation to support the application, ensuring that all necessary details are provided for eligibility determination.