dmas mmis webex training back to basics

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Department of Medical Assistance Services

DMAS MMIS WebEx TrainingBack to Basics

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Department of Medical Assistance Services

August 2012

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Department of Medical Assistance Services

Agenda• ADAPT File Clearance• Adding a New Case/Obtaining New Case ID

Number in the MMIS• Obtaining a Member ID Number• Adding a New Case and a New Member• Moving a Member to an Existing Case• Cancel Reason “001”• Retro Cancel Reinstate Reminder• Requesting a New Medicaid Card• Managed Care

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Department of Medical Assistance Services

ADAPT File Clearance

• Families and Children (F&C) MC applications are input into the ADAPT system to determine eligibility.

• File Clearance is the process of assigning an applicant a Client ID, which is the unique identifier in ADAPT. File clearing assists in determining if an applicant needs a new Client ID or if one has already been assigned.

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Department of Medical Assistance Services

File Clearance ExampleThe application is for three MC applicants:

After logging in to ADAPT the worker will perform a file clearance on each of the applicants listed on the application.

Name DOB SSN GenderMary Test 5/15/95 227-65-1111 FemaleTommy Test 6/15/2008 431-87-2233 MaleSusan Test 7/15/2010 421-64-1212 Female

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Department of Medical Assistance Services

File Clearance Example (continued) First navigate to the File Clearance screen:

From ADAPT Main Menu, select Option 1-Application RegistrationNext, select Option 5 - File Clearance MSI

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Department of Medical Assistance Services

File Clearance Example (continued)

ADAPT searches within its data as well as other systems such asMMIS to search for the applicant.

Input required data on the File Clearance screen and then select transmit (Xmit) to begin the system searches.

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Department of Medical Assistance Services

File Clearance Example (continued)

After validation, a prompt asking “Assign New Client ID?” appears.

Select (Xmit) agin and a data confirmation box is presented which requires the worker to reenter the DOB and SSN for validation.

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Department of Medical Assistance Services

File Clearance Example (continued)If applicant already has a Client ID the following screen will appear; use the existing ID - DO NOT create a new one.

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Department of Medical Assistance Services

Adding a New Case

• Select Case and Member• Enter the first 11 digits of the case ID number• Enter the Member ID number

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Department of Medical Assistance Services

Adding a New Case (cont.)

Mandatory Fields:• Last Name• First Name• Address• City• State• Zip Code• Case SSN• Caseworker • Case FIPS• Review Date• Relationship

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Department of Medical Assistance Services

Adding a New Case (cont.)

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Department of Medical Assistance Services

Adding a New Case & Member

Mandatory Fields:• Case ID• Member ID• SSN• Last Name• First Name• DOB• Gender

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Department of Medical Assistance Services

Add a New Case & Member

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Department of Medical Assistance Services

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Mandatory Fields:• Last Name• First Name• Address• City• State• Zip Code• Case SSN• Caseworker• Case FIPS• Review Date

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Department of Medical Assistance Services

Add a New Case & Member (cont.)

Mandatory Fields:• Relationship to Case

Head• Race• Marital Status• Primary Language• Cit Status• Cit Level• Identity• Country• Same as Case Address• Same as FIPS Address

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Department of Medical Assistance Services

Add a New Case & Member (cont.)

Mandatory Fields:• Aid Category• Application Date• Begin Date

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Department of Medical Assistance Services

Add a New Case & Member (cont.)

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Department of Medical Assistance Services

Moving a Member to Existing Case

• Select Case and Update• Enter the Case Number• Select Enter

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Department of Medical Assistance Services

Moving Member to Existing Case (cont.)

Enter: • Member ID• Member’s relationship • code to the case head • Select Enter to

validate information • Select Update to save

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Department of Medical Assistance Services

Moving Member to Existing Case (cont.)

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Department of Medical Assistance Services

Cancel Reason “001”• In the MMIS Cancel Reason Code “001” is

only used to close eligibility for deceased members; not to be confused with change reason “001” used in ADAPT.

• Screen help in the MMIS provides a complete list of cancel reason codes used in the MMIS to identify appropriate codes that best matches the member’s circumstances.

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Department of Medical Assistance Services

Certain Newborns - Tips• When enrolling certain newborns (NB) it is

important to remember:– Always enter the mother’s ID number on the

NB demographic screen.– Certain NB’s are enrolled with AC 093.– “NB” should be always be input in the identity

verification field. This allows the SSA match process to identify the member.

– Ensure the eligibility begins on the NB DOB – regardless of the application date!

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Department of Medical Assistance Services

Retro Cancel Reinstate – Reminder!• There are two Retro Cancel Reinstate reasons:

– 024; moving from limited coverage to greater limited coverage or full coverage

– 032; moving between AG and LTC or from FAMIS to Medicaid

• DMAS WebEx training on using the Retro Cancel Reinstate function is available in the Knowledge Center and on the EEU webpage at http://dmasva.dmas.virginia.gov/Content_pgs/dss-elgb_enrl.aspx.

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Department of Medical Assistance Services

Medicaid Cards• New Medicaid cards are issued when:

– New eligibility is entered and the member has never received a card or has not received one in more than one year.

– The member’s name, DOB, or sex is changed in the MMIS.

– The LDSS requests a replacement card in MMIS.

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Department of Medical Assistance Services

Medicaid Cards (cont.)• Three replacement cards may be issued by the LDSS.

After three cards have been issued an ID card reset form should be emailed to the DMAS EEU at enrollment@dmas.virginia.gov. (See Broadcast 3708)

• Medicaid cards returned as undeliverable are closed with a cancel reason “012”. The LDSS will need to reopen the eligibility after any necessary corrections are made.

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Department of Medical Assistance Services

Managed Care (MC) - Overview

• A member whose coverage is cancelled and not reinstated by MC cutoff (the 18th) will be dis-enrolled from the MCO.

• MC has a 60 day re‐enrollment process time if eligibility is reinstated within 60 days, there is no pre‐assignment, and the member is reassigned the first of the month after MC processing.

• If more than 60 days pass before reinstatement the member goes through pre-assignment.

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Department of Medical Assistance Services

Managed Care Enrollment ScenariosExample 1: Member cancelled 6/8/12 effective 6/30/12 & is not reinstated.Member dis-enrolled from MC effective 6/30/12.

Example 2: Member cancelled 6/8/12 effective 6/30/12 & reinstated 6/9/12 with 7/1/12 begin date. Member not dis-enrolled from MC.

Example 3: Member cancelled 6/8/12 effective 6/30/12. Member dis-enrolled from MC effective 6/30/12 during MC processing.Member reinstated on 6/19/12 with 7/1/12 begin date. Member reassigned to same provider during the MC run effective 8/1/12.

Example 4: Member cancelled on 6/8/12 effective 6/30/12. Member dis-enrolled from MC effective 6/30/12 during MC processing. Member reinstated on 7/19/12 with 7/1/12 begin date. Member reassigned to same MCO provider during the managed care run on 8/18/12 effective 9/1/12.

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Department of Medical Assistance Services

Managed Care - Tips• Enroll newborns with eligibility effective on their

date of birth

• ALWAYS add the mother’s ID to the Infant Mother ID field and NB to the identity field on the NB’s demographics screen.

• Update addresses and FIPS codes timely

• Complete changes by the 18th of the month or prior to MCO cutoff

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Department of Medical Assistance Services

Managed Care in the MMIS

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Department of Medical Assistance Services

Managed Care in the MMIS (cont.)

• Choose Member/PCP Assignment Data

• Select Inquiry • Enter the member ID # • Select Enter

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Department of Medical Assistance Services

Managed Care in the MMIS (cont.)

Fields of Importance:Preassignment Reason Assignment Data Benefit Plan Reassignment DataException Status Data

Change Code

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Department of Medical Assistance Services

Managed Care AssistanceQuestions or Issues with Managed-Care Enrollment:

• Members can contact the Managed Care Helpline by phone at (800) 643-2273;

• Through the managed care website at: www.virginiamanagedcare.com;

• Or by email at: managedcarehelp@dmas.virginia.gov

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Department of Medical Assistance Services

Remember…• Send all questions and proposed topics to

mmiswebex@dmas.virginia.gov • If you have viewed this part of the

presentation through the Knowledge Center, don’t forget to join the DMAS Enrollment Unit for our live WebEx sessions.

Thank You!