APPLICATIONS & CLAIMS

APPLICATIONS & CLAIMS 

Manage sponsor applications, program compliance, claims reimbursement, and more. 

Programs

SNP | CACFP | SFSP

Customers

Key Benefits & Features

  • Access data analytics at the site, sponsor or state level

  • View a full history of tracked changes

  • Save forms “as you go” with partial saving feature

  • Filter all claims by program, status, amount, and more

  • Auto-populated user and site-based information

  • Generate claims in various supported formats
  • Easily configure state reimbursement rates
  • Multi-level application approval

Sponsor Applications

In PrimeroEdge, State agencies to view and add applications for all eligible sponsors. Sponsor then would be able to create applications, which includes sponsor applications, site application(s), budgets as applicable, management plan, documents, etc. Application tabs and questions are dynamic based on the sponsor form responses by SFA/Sponsor. Applications and history from prior years are easily available to review for audit purposes. New site applications allow the user to copy program and meal data from a similar site, such as elementary school to elementary school.  Renewal applications bring all the prior year’s data to current application for fast and easy submission.

Configuration

The State agency will be able to configure dates that allow sponsors to file application and claim submissions as well as upload documents for applications based on type, program association, return method, etc. Documents within the application are tracked in the Documents tab, along with View, Return, and Acceptance Tracking by date. PrimeroEdge utilizes an SFA-visible and SA-controlled system functionality to show sponsors only the information they need to access. The Application particulars tab includes the FEIN, SEIN, Unique Entity ID, Agency codes, etc. All CFDA codes are managed by program and are displayed on claim-related documentation to assist in proper financial account tracking.

Reduce Data Redundancy

PrimeroEdge will store data entered for the Sponsor/Site information such as address and official details to prevent duplication of data entry efforts from year to year. The system will also store information specific to the application packet year. Contacts can be added during the application process if they are not already entered at the Sponsor/Site level. Sponsor/Site particulars are managed at the State agency level within the Claims and Applications module.

Application Question Formatting

Application questions are separated into Sponsor and Site level application questions. Program classification for every sponsor is determined by the approved application packets. The software prepopulates the site application for afterschool snack enrollment data from the most recent October data (prior year claims) and uses that to determine the area eligibility of the site.

PrimeroEdge utilizes a dynamic approach to the questions within the application. As a user answers the questions, additional questions may appear, or subsequent questions may become disabled. This approach streamlines the application entry and renewal process by displaying only relevant information. This also helps eliminate confusion and requests for clarification. Where applicable, the system will warn the user that an entry is invalid with clear messaging to help address the error. PrimeroEdge built in intelligence presents only the agreement questions that are pertinent to that sponsor. Questions that are not applicable will not be displayed for the user, thus making the application process quick and easy. 

Sponsor Claims and Reimbursement

PrimeroEdge allows entry and processing of monthly claims for reimbursement, for all Child Nutrition Programs. Both manual and file import entry are supported for all reimbursement claims. The solution tracks all communications and modifications between SFA/SA, as well as maintains a history of all details related to a sponsor’s claims.

Built-in Data Validation and Edit Checks

PrimeroEdge validates data entry in multiple ways.  Data is validated at the point of input for format and data type. Only numeric field may be entered for meal counts. Specific formats are check as the data is entered, such as dates, phone numbers, and zip codes.  Depending on page function when the page is saved the required fields wills be analyzed and highlighted if incomplete.  The system utilizes both warnings and errors. Warnings allow the user to move to the next step, but errors will not allow the user to proceed without correction.

The PrimeroEdge solution will not allow submission of a claim that contains errors. The SFA will be provided detailed feedback on which items require a change. The solution allows SFA submission of a claim with warnings but will not allow payment processing without SA review and approval.

Both error- and warning-level edit checks are built-in for the submitted claim information. Claims with errors are not allowed to be submitted to the State agency. State agency staff are allowed, based on user role permissions, to override the system checks. Comments are required for any override.

Revisions Ability

Revisions can be easily made to a claim. Our software allows multiple revisions in every status of the claim. SFA/Sponsors can revise the claims any number of times until the claim is approved for Payment Processing. Once there, SFA can still do adjustments up to 10 times. Upward adjustments that are past the 60-90 day claiming period will have to go through a State agency extension review process. The SA would then review and either approve for additional payment for claim difference, or deduction from a future claim. The PrimeroEdge solution supports claim submission at the site level and payment processing at the district level.

Uploading Claims

After claims are uploaded, SFA would then resolve any system warnings and confirm submission of the claim data for payment processing. Users will be required to provide meal and/or milk counts by program considering the student-based or site-based eligibility approval. Meal/milk counts greater than approved/enrolled students are not permitted by the system. The PrimeroEdge solution works seamlessly with the application approval to only allow the entry of claims for approved meal types for months approved. Claims are not allowed to be submitted for a month prior to the effective date of the approval or for a month where claims are suspended.

Processing Claims

The PrimeroEdge solution will compare information provided in the site application regarding school start, school end, days and months of operation to perform a reasonable test to the number of meals claimed. Depending on claim payment status, the system will indicate the amount of adjustment to be made, addition or subtraction, to the next payable claim.

The state agency will have the ability to determine the deadlines for claim submission and upward adjustments. If a sponsor submits a claim beyond the established deadline the claim is flagged, the sponsor is required provided a reason, and the state agency may grant an exception.  The system tracks the exceptions by sponsor so they can be reviewed as needed. Overrides are required if an exception has already been used within the USDA specified timeframe.

Batch Tracking and Financial File Export Capabilities

PrimeroEdge solution will allows the State agency to pick multiple sponsor claims for payment processing and provide reporting for the claim details in a batch format. Financial exports to the state’s payment system can be built as required by the State Agency.

Tracking Meals Claimed

The PrimeroEdge solution tracks all meals through POS (if used), otherwise through file upload or manual entry of data for all categories, programs, by eligibility type. The solution follows all rules and rounding calculations as provided under USDA guidance when determining free and paid claiming percentages for meal claims under CEP and Provision 2.

Creating new SFAs (sponsors)

The PrimeroEdge solution allows for creating new SFAs (sponsors) through either manual entry or bulk import through a file upload. An additional option is the pre-application function for potential sponsors to complete a form indicating their interest and supply minimum required information. That information is displayed for the State agency to review and create a new sponsor within the solution, where applicable. The PrimeroEdge solution is already configured to contain SFA and site information. Additional sites can be added as needed.

Preloaded USDA Information

USDA income guidelines, reimbursement rates, and application criteria are built into the software. Guideline updates can be downloaded from the PrimeroEdge website or are sent out annually with the update.

Program Configuration and Provisions

PrimeroEdge allows configuration of Reimbursement Rates and utilizes previously submitted claim to determine the Category of Reimbursement the SFA is entitled to for the given academic year. Program configuration, such as severe need breakfast, area eligible snack, and special provisions are configured automatically based on the packet approval process. PrimeroEdge allows for entry of CEP details for USDA reporting and allows the SFA to use that information to apply for participation in CEP. There is also an analysis feature that allows the SFA to move sites into and out of a group to determine the best configuration for highest reimbursement. Reimbursement rates are configured in the system by Academic Year. The configured rates are used to calculate claim totals by multiplying the submitted meal counts by the state agency configured rates for each sponsored program.

Available Reports

PrimeroEdge Applications and Claims provides a variety of advanced reports at both the State and SFA level, including Claims Payment, Meal Participation, Site Status, USDA/FNS Reporting, and October Data. Users can quickly and easily view data across all programs, by type, SFA, period, and status Each report can be exported into a wide range of formats including Word, Excel, PowerPoint, PDF, TIFF, MHTML, CSV, XML, or Data Feed.

Key information captured by PrimeroEdge’s Applications and Claims includes:

  • Approved programs and mealtimes
  • Prices charged for meals/milk
  • Months of participation by program
  • Type of SFA (i.e., public school, RCCI, etc.)
  • Offer vs. Serve option
  • Food Management Service Company contract data
  • Alternative provisions (Provisions 1, 2, 3 and Community Eligibility Provision)
  • Program participation
  • Severe need breakfast