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SUBSIDY CLAIM FORM GUIDENAVY FEE ASSISTANCE PROGRAM | JULY 2020
SUBSIDY BENEFIT CLAIM PROCESS
PROPERLY COMPLETE THE SUBSIDY CLAIM FORM
MUST BE SIGNED BY BOTH THE SPONSOR + PROVIDER
SUBMIT TO: [email protected]
FOR PROCESSING
CYP SUBSIDY CLAIM FORM (SCF)Subsidy benefits are awarded to eligible families where care occurs via an approved qualifying provider. Award limits are determined by policy.
CYP SUBSIDY CLAIM OVERVIEW
Subsidy Benefit Award Notice
Both the sponsor + the provider receive a Subsidy Award Notice advising subsidy benefits for qualifying child or children.
o Identifies Sponsor Navy Sponsor ID, Navy Provider ID, and child/children
o Provides approved subsidy benefit award per child with effective date (Month, Day, Year)
o Attaches Subsidy Benefit Claim Form
o Instructs “How to Submit A Claim”
o Instructs “How to Renew” + “When to Renew Subsidy Benefits”
o Benefits are valid for the date range displayed in the upper left hand corner, typically up to 1 year
Subsidy Claim Procedures
Either the Sponsor OR the Provider may submit the Monthly Subsidy Claim Form (SCF) for processing.
o The SCF is pre-populated with account information (i.e., provider information, family information, type of care, subsidy claim information)
o Strike a single line through the Monthly Child Care Fee if there is a change in provider fees for the month. Write in the actual fee next to it. If care was not provided for the full month and there are no adjusted fees due to the limited care, make sure there is “No Adjustments” added to the claim form.
o Specified changes in care which may result in “fee adjustment(s)” impacting total parent fee + total monthly subsidy are recorded within the calendar blocks of Section V. Daily Attendance in not.
o Provide an explanation for ALL strike through annotations and codes recorded. This information is used by Claim Support Services to determine what Total Monthly Subsidy Adjustment applies (if applicable).
THE SECTIONSThe SCF is broken into six sections. Sections 1-4 contain pre-populated account information with multiple highlighted fields within the form requiring action.
SAMPLE SCF: SECTIONS I-II
Top of form: Displays date benefits begin AND end in upper left hand corner (Do not alter). Sponsors must submit a new application + supporting documentation to renew eligibility 45-days before the end date on this form to avoid a lapse in benefits.
1. Monthly Subsidy Benefit Claim for Month/Year of:select this information from the calendar; the month must be selected for the month claimed; if no month is entered here, the claim is rejected.
2. The block to the right will contain an electronic Navy CAC signature when subsidy benefits are awarded.
Section I - Provider Information: displays qualifying provider name, billing email (not the director unless claims/invoices come from this individual), and the Navy Issued Provider Number (AKA: Vendor Number).
Section II - Family Information.: displays sponsor name, Navy issued Sponsor ID Number, and Child’s name.
SAMPLE SCF: SECTIONS III-VISection III – Type of Care: Displays if care is full-time (25+ hours per week) or part-time (11-24 hours per week) and the program offering (e.g., year-round, school year, summer).
Section IV – Subsidy Claim: displays sponsor rank, duty zip, high cost designation (marked if applicable); Monthly Child Care Fee, Total Parent Fee, Total Monthly Subsidy.
1. Monthly Childcare Fee: provided by the provider on the Cost Worksheet
2. Total Parent Fee: calculated based on Sponsor Rank and Active Duty Station
3. Total Monthly Subsidy: calculated maximum benefit based on Sponsor Rank, Active Duty Station, and Market Cap per policy formula. Note: when childcare fee exceeds the market cap per policy (e.g., the maximum benefit allowed); the different is the family responsibility and added to the Total Parent Fee.
Section V - Explanation of Fee Adjustments: when fee adjustments is required (i.e., First Day of Care, Last Day of Care, No Charge of the Day, Other) this is recorded on the date of the month the change occurred using the codes specified. All markings to a form MUST be explained. Do not input amounts on the right side of this section, Claim Support will use this section to make the adjustments.
Section VI – Signature: claim forms are invalid until signed and must be signed by the Provider + Sponsor or rejected.
PREPARE THE CLAIM Submit monthly claims after children attend care and family fees are collected.
PREPARE + SIGN + SUBMIT 1. On or around the last day of each month, prepare and sign
the Subsidy Claim Form (Provider) 2. Both Provider + Sponsor will review the claim form. Once
agreed it is correct, both sign + it is submitted.
Subsidy claim forms are submitted via email to:
SAMPLE SCF – PROPERLY COMPLETEDProperly Completed claims with No Adjustments: 1. Month claiming is entered at the top of form.2. Provider signs the claim form. 3. Sponsor signs the claim form.4. Submit to: [email protected]
Do Not Adjust Sections IV-V, Enter Month, Sign, Date + Submit Only!
(Applicable during months where no adjustment occur)
COMMON ERRORS: TOP OF THE FORM
SUBSIDY BENEFIT CLAIM FOR EFFECTIVE DATES
1. The Subsidy Claim Form is an Adobe PDF Fillable Form with interactive features such as calendars and electronic signatures. Search “Adobe Reader” and download the drivers for your operating system for the best user experience.
2. The Dates displayed in these blocks show how long the claim form is good. It is not to be altered.
3. If altered, the claim is rejected. Do Not Alter.
MONTHLY SUBSIDY BENEFIT CLAIM FORM MONTH/YEAR OF
1. Select the Month and Year you are claiming from the calendar feature.
2. Click in the highlighted block, a calendar pops up, make your selection.
3. When left blank, the claim is rejected. Do Not Leave Blank.
Electronically Signed by Navy CYP Staff.
SAMPLE SCF – PROPERLY COMPLETED ADJUSTMENT (FIRST DAY OF CARE)
Properly Completed claims with Adjustments: 1. Month claiming is entered at the top of form.2. Draw a line through the original MONTHLY CHILDCARE
FEE and annotate the new adjusted MONTHLY CHILDCARE FEE amount.
3. Annotate the child’s first day of care with “FD”.4. Explain the child’s start date was 9 July and the Care Fee
was adjusted. 5. Provider signs the claim form. 6. Sponsor signs the claim form.7. Submit to: [email protected]
Annotate Adjustment(s) in Sections IV-V Do Not Calculate Fees – Navy CYP USE Only
Enter Month, Sign, Date + Submit Only(Applicable during months where adjustment(s) occur)
SAMPLE SCF – PROPERLY COMPLETED ADJUSTMENT (NO CHARGES)
Properly Completed claims with Adjustments: 1. Month claiming is entered at the top of form.2. Draw a line through the original MONTHLY CHILDCARE
FEE and annotate the new adjusted MONTHLY CHILDCARE FEE amount.
3. Annotate the child was not charged 13-17 July. 4. Explain the child was not charged 13-17 July and the Care
Fee was adjusted.5. Provider signs the claim form. 6. Sponsor signs the claim form.7. Submit to: [email protected]
Annotate Adjustment(s) in Sections IV-VDo Not Calculate Fees – Navy CYP USE Only
Enter Month, Sign, Date + Submit (Applicable during months where adjustment(s) occur)
COMMON SCF ERRORSMonthly claim forms are routinely rejected due to common errors that occur when completing the form.
COMMON ERRORS: SECTION IV-VSUBSIDY CLAIM + EXPLANATION OF FEE ADJUSTMENTS
1. When MONTHLY CHILDCARE FEE is not accurate because of adjustments, follow directions 1-3 in Section IV & V.
a) Subsidy is based on actual charges, it is very important annotations are correct before submitting.
b) Use ONLY the codes provided to annotate the change in feesc) Explain why the MONTHLY CHILDCARE FEE is now different in the
“Explanation of Adjusted Fees (required) field. Do not enter any amounts to the right of this field. Claim support will use this field to calculate the adjustments
d) If there was not a full month of care and the care fee did not change due to the limited care, annotate “No Adjustments” in the Explanation field
e) DO NOT alter any other blocks in these sections.
2. Provider + Sponsor will review the claim form. Once agreed it is annotated correctly, both sign + it is submitted.
