How do I create a Philadelphia Annual Reconciliation form?

Creating the Annual Reconciliation form

  1. Click on the Payer List button.
  2. Choose the payer.
  3. Click on the Payer State Info button.
  4. Click Add.
  5. Choose PA from the State drop down menu.
  6. Enter applicable state information.
  7. Click Save.
  8. Click Locality.
  9. Choose the appropriate locality from the Locality drop down menu.
  10. Enter the Account Number. The account number will need to be 10 digits.
  11. Enter the Political Subdivision (PSD) Code. The PSD Code must be 6 digits.
  12. Click Save.
  13. Click OK.
  14. Click on the Add Form button.
  15. Choose Philadelphia from the Federal/State/Local drop down menu.
  16. Choose Annual Reconciliation from the Form Name menu.
  17. Click OK.
  18. Enter the applicable information. 
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