Section 4 Automation Guide

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Section 4 Automation Guide Powered By Docstoc
					Section 4: Automation Guide

4.1   Hardware Requirements
4.2   Security/Confidentiality
4.3   Software Updates
4.4   Technical Assistance
4.5   General Instructions
      4.5.1 Navigation
      4.5.2 Hyperlinks
      4.5.3 Pop-up Menus
      4.5.4 Multi-Select List Box
      4.5.5 Other Page Controls
      4.5.6 Client Listings
      4.5.7 Symbols
4.6   Accessing SIEBRS
      4.6.1 SIEBRS Main Menu
4.7   Screening
      4.7.1 Retrieving an Existing Household
      4.7.2 Creating a New Household
      4.7.3 The Household Page
      4.7.4 Adding New Clients
      4.7.5 Modifying Existing Client Records
      4.7.6 Adding an Existing Client
      4.7.7 Removing a Client from a Household
      4.7.8 Household Relationship Information
      4.7.9 Household Contact Information
      4.7.10 Household Questions
      4.7.11 Screen Household
      4.7.12 Automatic Eligibility Terminations
      4.7.13 Screening Referral Information
      4.7.14 SDI Eligibility
      4.7.15 Documentation
      4.7.16 Self Declaration
      4.7.17 Rights and Responsibilities
      4.7.18 Make Clients SDI Eligible
      4.7.19 Screening Information
4.8   Eligibility
      4.8.1 Presumptive Eligibility
      4.8.2 Confidential Teen

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       4.8.3 Limited Services
       4.8.4 Family Planning Only
       4.8.5 Terminating SDI Eligibility
4.9    Service Codes
4.10   Diagnosis Codes
4.11   Service Entry
       4.11.1 Service Entry Functions
       4.11.2 Service Entry Using the Code Selection
               Menus
       4.11.3 Manual Service Entry
       4.11.4 Recouping Payments
       4.11.5 Service History
4.12   Payment Inquiry
4.13   Client List
4.14   Provider Inquiry
       4.14.1 Provider Information
       4.14.2 Contract Information
       4.14.3 Copayment Information
       4.14.4 Payment Information
4.15   Reports
4.16   Maintenance
       4.16.1 Deleting a Client
       4.16.2 Clinic Affiliation
       4.16.3 Accessing the Training Provider
       4.16.4 Referral Information
4.17   Notices




                         4- 2
Chapter 4: Automation Guide (updated 04/01/2008)
4.0  Introduction
      SIEBRS (SDI Integrated Eligibility, Billing and Reporting System) is an
      Internet based computer application developed by DSHS (Department of
      State Health Services) to automate screening, enrollment, billing and
      reporting for multiple DSHS programs. SIEBRS was developed in
      response to a need to simplify administrative operations for DSHS
      contractors. Client eligibility and service delivery information is maintained
      by the system and used to provide weekly electronic reimbursements and
      automate programmatic reporting requirements.

4.1 Hardware Requirements
      SIEBRS use requires a personal computer, Internet connection and 128-
      bit capable web browser. Each SDI contractor is responsible for selecting
      and supporting the Internet connections, personal computers and web
      browsers required to access the SIEBRS web site.

4.2   Security/Confidentiality
      The information maintained by the SIEBRS web site is considered
      confidential medical information. To protect this information, the system
      requires individual login authentication and uses Secure Sockets Layer
      (SSL) protocol with a 128-bit encryption key to encrypt all data that is
      transmitted between the web server and the users web browser. The
      following security policies have been established to provide additional
      protections at the contractor sites.

      Limited Access
      Only contractor staff that require access to confidential medical
      information as a part of their job functions should have access the
      SIEBRS system.

      Notification of Termination


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      It is the contractor’s responsibility to notify DSHS immediately when a user
      who has access to the SIEBRS system no longer requires access for any
      reason.

      Sharing Prohibited
      Each SIEBRS user must have a unique user identifier and password. The
      sharing of user identifiers and passwords between users creates a
      significant security risk and is prohibited.

      Automated Access Prohibited
      Web browsers include a feature that stores the user identifier and
      password for automatic use when accessing a web site that requires
      authentication. The use of this feature creates a significant security risk
      and is prohibited for accessing the SIEBRS web site.

      Screen Saver Required
      Each computer from which the SIEBRS web site is accessed must have a
      timed, password protected screen saver to prevent unauthorized access.
      Additionally, the web browser should be closed to prevent unauthorized
      access if a user is not physically present at the computer where the site is
      accessible.

4.3   Software Updates
      DSHS updates the SIEBRS application software when necessary to
      include policy changes or to add new features. Significant changes will
      appear in the ‘Notices’ area accessible form the SIEBRS Main Menu.
4.4   Technical Assistance
      The contractor is responsible for designating technical assistance and
      technical support staff to assist users in accessing and navigating
      SIEBRS. SDI IT staff support the SIEBRS web site and application
      software. They do not support the contractor’s Internet access, web
      browsers, personal computers, printers, e-mail or related software.

      The user follows the steps below for technical assistance.


       Step Procedure
        1     Self-help. Research the SDI Contractor Manual for assistance.
              Use the “find” function under “edit” or the “search” function and
              enter the topic or subject you want to research. In addition to
              the manual, search the SIEBRS Notices for answers to
              technical questions.
        2     Onsite technical support. If unsuccessful using the self-help
              method, contact local, onsite technical support or technical
              assistance staff. Note: The technical support staff should be


                                      4- 4
              able to determine whether a problem is a true IT issue and
              resolve the problem at the local level.
         3    SDI IT staff. If onsite technical support staff is unable to
              resolve the problem, the tech local staff can call Austin SDI IT
              to obtain needed information.

4.5   General Instructions
      4.5.1 Navigation
      SIEBRS navigation refers to the screen controls and general methods
      used to operate the SIEBRS web site.

      4.5.2 Hyperlinks
      Hyperlinks are navigation controls that link to a different area of an
      application or to a location within the current page. Each page viewed in
      SIEBRS includes a page header that contains hyperlinks. A graphic
      symbol to the left of the hyperlink identifies whether the link is associated
      with a different area of the application (inner-page) or to a location within
      the current page (intra-page).

                            Links to a different area of the
Inner-Page Hyperlink                                                SIEBRS Main
                            application.
                            Links to a location within the
Intra-Page Hyperlink                                               Contracts
                            current page.
                             Inner-page Hyperlink
                                                    Intra-page Hyperlink




      4.5.3 Pop-up Menus


      It is not necessary to use the mouse to make a selection from a pop-up
      menu control. Pressing the first letter or number of the item that you are
      seeking in a pop-up menu will cycle the selections through the available
      items that begin with that letter or number.

      For example, there are five counties that begin with the letter N;
      Nacogdoches, Navarro, Newton, Nolan, and Nueces. When the cursor is
      in the County field and the letter N is pressed, Nacogdoches is selected.
      Pressing the letter N again selects the second item that begins with the
      letter N, Navarro. Pressing the letter N a third time selects the third item
      that begins with the letter N, Newton.


                                      4- 5
4.5.4 Multi-Select List Box
To select items from a multi-select list box, hold down the Control key and
select each item to be included by clicking on it with the mouse. Clicking
on the same item a second time will deselect that item. Use the mouse to
move the scroll tab up or down to view other items for selection.


                                                            While holding down
                                                            the Control key, use
                                                            the mouse to move
                                                            the scroll tab up or
                                                            down to view other
                                                            items for selection.




4.5.5 Other Page Controls
Press TAB to move from object to object within the same page. Press
ENTER to select the highlighted command button or make a selection
from a pop-up menu.

Access Keys
Access keys are keyboard shortcuts that execute functions. The blue
bullets that appear in conjunction with a function represent the
corresponding access key. Hold down the Alt key and press the letter or
number to execute the function. The Alt+Left-Arrow and Alt+Right-Arrow
access keys are shortcuts for the browsers back and forward controls.

Access Key (Alt-S)


4.5.6 Client Listings
SIEBRS stores client names in LAST,FIRST MIDDLE format. To select
clients using the List Clients command, enter part, or all, of a client’s name
in the text field area, then click on the           button. If more than 25
names match the search parameter, a Continue button is displayed at the
bottom of the page. Clicking the            button displays more client
names that match the search parameter. Commands similar to the List
Clients command are used throughout SIEBRS.


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                                                            The Continue button is
                                                            displayed if more than
                                                            25 items match the
      4.5.7 Symbols                                         search parameter.


                      The blue bullets identify logical commands in
                      SIEBRS.
                      This graphic identifies an intra-page hyperlink
                      used for accessing different areas of the same
                      page.
                      The gold star indicates that a command has been
                      completed successfully.
                      The red “X” identifies an error message.

                      The blue ‘i’ identifies a message that is for
                      informational purposes.
                      Selecting the search history icon displays a list of
                      recently entered search parameters such as
                      name or service code

4.6   Accessing SIEBRS



           Open the web browser (i.e., Firefox, Mozilla, Netscape, Internet
           Explorer).
           Sign on to SIEBRS by typing https://siebrs.tdh.state.tx.us in the
           address field of the web browser.


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      After typing the site name in the address field, the browser’s
      drop-down URL list may be used to access the SIEBRS web
      site.
                                                   Drop Down URL List




The SSL security certificate must be accepted to use the SIEBRS
web site. Continue through any certificate warning messages until
the SIEBRS home page is displayed.
            SIEBRS Home Page

                                              User identifiers and
                                              passwords are case
                                              sensitive. Use lower
                                              case letters without
                                              spaces when entering
                                              the user identifier and
                                              password.




From the home page, click on the button that reads:

Enter the user name and password that was assigned by DSHS.
Password sharing is prohibited for security reasons. All users must
have a unique user identifier and password.
       User identifiers and passwords are case sensitive. Use
       lower case letters without spaces when entering the user
       identifier and password.

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4.6.1 SIEBRS Main Menu




           Screening is used to screen households for potential
           eligibility in non-SDI programs and to enroll clients in the SDI
           program who are determined eligible through the screening
           process
           Eligibility is used to enroll individual clients for Confidential
           Teen, Presumptive Eligibility, and Limited Services eligibility
           types and to terminate SDI eligibility
           Services is used to enter services delivered to SDI clients
           for payment and to recoup erroneously paid services
           Payments is used to perform payment inquiry on clients and
           services previously entered for payment
           Clients is used to create a custom list of SDI eligible clients
           based on the SDI eligibility period
           Provider is used to monitor contract balances, co-payments,
           and claim processing information
           Service Codes is used to maintain the
           service/pharmaceutical selection menus used in the service
           entry function
           Diagnosis Codes is used to maintain the diagnoses
           selection menus used in the service entry function
           Reports is used to view the eligibility and service reports,
           the Medicaid client list, the recertification client list, and the
           Federal Poverty Income Limits tables
           Maintenance is used to delete clients from the SIEBRS
           system, set an individual users clinic affiliation and to add
           localized contact information to the Screening Referral
           Information page


                             4- 9
                     Notices is used to provide information on changes made to
                     the automation system
                     SDI Manual is an external link to the current version of the
                     SDI Policies and User manual

4.7   Screening
      The Screening function screens households for potential eligibility in non-
      SDI programs and enrolls clients in the SDI program who are determined
      eligible through the screening process.

                     A household includes all persons who occupy a
                     housing unit regardless of their relationship. All
                     household members should be entered as a group and
                     included in a single screening process. The programs
                     included in the screening module will create family groups
                     that conform to their eligibility requirements.
                     It is the contractor’s responsibility to ensure that a client
                     has SDI eligibility before delivering services with the
                     expectation that SDI will reimburse for those services.
                     SDI will not backdate eligibility or reimburse for services
                     for any period where a client does not have SDI
                     eligibility established in the automated system.

            Select            from the SIEBRS main menu.

                               SIEBRS Main Menu




                     Select                          to create a new household.
                     Select              to retrieve an existing household.




                                     4 - 10
                   Household Selection Page

                                                        Search History icon




            Selecting the search history icon,      , displays a list of
            recently entered search parameters.




4.7.1 Retrieving an Existing Household

      Enter part, or all, of the client’s name in LAST,FIRST MIDDLE
      format and select              or use the search history       to
      retrieve an existing household.

                   Household Selection Page




            The               command displays each client’s latest SDI
            eligibility segment and latest Medicaid eligibility period.




                             4 - 11
                    Household Selection Page
                       Latest SDI eligibility type          Latest Medicaid
                       and eligibility period               eligibility period




         SDI Family
         Planning indicator

                                   Re-screening indicator




              SDI eligibility is determined using household composition.
              When a client is deleted from the system or removed from a
              household, the household composition changes and the
              remaining household members must be re-screened for
              continuing eligibility. A Y in the Screen field of the client
              listing indicates that the household composition has changed
              and the household must be re-screened.
              Verification of SDI eligibility using the automated system
              must be performed each time a client visits the clinic.
              Various automated events, such as the identification of
              Medicaid eligibility, will terminate a client’s SDI eligibility.
              Clients may be eligible for SDI services, but not eligible for
              SDI Family Planning services. A Y in the FP column of the
              SDI eligibility information area indicates that a client is
              eligible for SDI Family Planning services.


                   SDI Eligibility Type Indicators

SDI       Full SDI eligibility
SDI-PE    Presumptive eligibility
SDI-CH    CHIP supplemental eligibility. Family Planning services.
SDI-LS    Limited Services eligibility. SDI-LS services are only
          available to Tuberculosis Elimination contractors


                               4 - 12
     SDI-CT   Confidential Teen prenatal and family planning eligibility.
              SDI-CT Family Planning services are only available to
              Title X contractors
     SDI-FP   Family Planning only eligibility. SDI-FP services are only
              available to Title X contractors.

                  A blank Medicaid eligibility close date indicates that the
                  eligibility period is on going. The
                                                  located in the       section of
                  SIEBRS shows any additional Medicaid eligibility segments
                  and the specific Medicaid program type.

           Click on the               to retrieve all of the household members.
                          Household Selection Page

4.7.2 Creating a New Household

           To create a new household, select                           from the
           Household Selection page.
                 A household includes all persons who occupy a
                 housing unit regardless of their relationship. All
                 household members should be entered as a group and
                 included in a single screening process. The programs
                 included in the screening module will create family groups
                 that conform to their eligibility requirements.

                  The Client List on the Household page will be blank when
                  creating a new household. Follow the instructions in the
                  Add New Client section of this document to add clients to
                  the new household.


                              Household Page
                                                  The Client List on the
                                                  Household page will be
                                                  blank when creating a
                                                  new household




      4.7.3 The Household Page

                  The Household page contains three sections:



                                   4 - 13
      Client List
      Household Contact Information
      Household Questions
The                      hyperlink at the top of the
Household page or the                      button at the
bottom of the Household page initiate the screening process.




                4 - 14
Household Page

                 The intra-page
                 hyperlinks may be
                 used to access the
                 various sections of the
                 household screen.




                  The Household screen
                  includes three sections.
                  The Screen Household
                  button is at the bottom
                  of the Household
                  screen.




      4 - 15
            Select                               to add clients to a new
            household or to add new clients to an existing household.
            Click on the               to access and modify an existing
            client record.
            Select                                to move a client from a
            different household to the current household.

4.7.4 Adding New Clients

     Select                              to add clients to a new
     household or to add new clients to an existing household.

                       Household Page




                                        Select Add New Client to add
                                        clients to a new household or
                                        to add new clients to an
                                        existing household.

     After entering the required information, select
     to store the information.
            The Patient Identifier is an optional field that may include a
            proprietary identification number that will be associated with
            the client and payment records.
            The SSN must be requested, but is not required.




                             4 - 16
       Client Information Page




Using the Calc (Calculator) Fields
Javascript must be enabled in your browser for the calculator
to function. The calculator will automatically apply the result
to the associated input field when the tab key is pressed
within the Calc field.




                 4 - 17
  Functions              Order of Operations                    Examples

                                                          230.25 * 4.33 = 996.98
Multiplication * 1. equations inside parentheses          100 + 100 * 2 = 300.00
Division       / 2. multiplication/division left to right (100 + 100) * 2 = 400.00
Addition       + 3. addition/subtraction, left to right 100 / 2 * 4.33 = 216.50
Subtraction -                                             (100 - 50) * 4.33 = 216.50


             After adding all members to the household, click on the
                             hyperlink to return to the Household page.

      Modifying Existing Client Records

             From the Household Page, click on the                    to view the
             client information page for an existing client.

                                Household Page




                                   Click on the client name to view
                                   the client information page.




                    Each client’s SDI eligibility history is displayed at the top of
                    the Client Information page.
                    The Patient Identifier is an optional field that may include a
                    proprietary identification number that will be associated with
                    this client record.
                    The Client Information page header includes a
                    hyperlink that will provide accelerated access to the Service
                    Entry function.


                                      4 - 18
                                            The Client Information page
       includes a function to remove the client from the existing
       household. See section 4.7.7, Removing a Client from a
       Household, for an alternate method.
       A household includes all persons who occupy a housing unit
       regardless of their relationship. Removing a client from a
       household will remove any existing address information for
       that client
       SDI eligibility is determined using household composition.
       When a client is deleted from the system or removed from a
       household, the household composition changes and the
       remaining household members must be re-screened for
       continuing eligibility. A Y in the Screen field of the client
       listing indicates that the household composition has changed
       and the household must be re-screened.
                               If a client has current SDI eligibility, the
       Client information page will include a function to terminate
       SDI eligibility. Eligibility should be terminated one day prior
       to the current date if the client will be re-screened for SDI
       eligibility after being added to or removed from a household.
                                            The Client information page
       will include a function to permanently delete the client record
       from the SIEBRS system if the client does not have payment
       records. Clients with payment records cannot be deleted
       from the system.

After entering the updated client information, select
                      to store the information.




                         4 - 19
                      Client Information Page


                                                Service Entry Link
Eligibility History




  After saving the client information changes, click on the
                  hyperlink to return to the Household page.




                              4 - 20
4.7.6 Adding an Existing Client

      Select                               from the Household Page to
      move a client from a different household to the current household.

                        Household Page




                                        Select Add Existing Client to
                                        add an existing client to the
                                        current household.


      Click on the              to add the client to the current
      household.




                             4 - 21
               Add Existing Client Page




Click on the client name to add an
existing client to the current household.


       Clients may not have SDI eligibility in multiple households.
       Any current eligibility in the old household must be
       terminated before adding the client to a different household.
       Terminate existing eligibility one day prior to the current date
       if the client will be re-screened for SDI eligibility after being
       added to or removed from a household.
       SDI eligibility is determined using household composition.
       When a client is deleted from the system or removed from a
       household, the household composition changes and the
       remaining household members must be re-screened for
       continuing eligibility. A Y in the Screen field of the client
       listing indicates that the household composition has changed
       and the household must be re-screened.
       A household includes all persons who occupy a housing unit
       regardless of their relationship. Adding a client to a
       household will reset the client's address information to that of
       the current household




                         4 - 22
You will be prompted to terminate SDI eligibility if the client has current
eligibility in a different household. Modify the eligibility termination date
as appropriate and then select                         .

                  Add Existing Client Page




                                                             Modify the default
                                                             termination date as
                                                             appropriate and then
                                                             select Terminate
                                                             Eligibility.




                             4 - 23
     Removing a Client from a Household

To remove a client from a household:
      Access the individual Client screen by selecting the hyperlinked
                        in the Household Page
       Terminate any current eligibility for the applicable client in the
      old household using the                          function at the
      bottom of the Client screen
      Select                                    at the bottom of the Client
      screen to remove the client from the household
      To create a new household for the client being removed:
      Create a new household using the
      function in the Household Selection screen
      Use the                                   function to move the client
      into the new household
          ✔ When a client is deleted from the system or removed from
              a household, the old and new households must be re-
              screened for continuing SDI eligibility
          ✔ A household includes all persons who occupy a housing
              unit regardless of their relationship. Removing a client
              from a household will remove any existing address
              information for that client

                SDI eligibility is determined using household composition.
                When a client is deleted from the system or removed from a
                household, the household composition changes and the
                remaining household members must be re-screened for
                continuing eligibility. A Y in the Screen field of the client
                listing indicates that the household composition has changed
                and the household must be re-screened.

  4.7.8 Household Relationship Information

         Select                                 to access the Household
         Relationship page.




                                 4 - 24
                        Household Page




       Enter the relationships for each household member then select
                              to store the information.

                Household Relationship Page




     Click on the                hyperlink to return to the Household
     page.

4.7.9 Household Contact Information

     Click on the                       hyperlink or use the browser’s
     scroll bar to locate the Contact Information section on the
     Household page.


                             4 - 25
Enter the contact information and select
to store the information.
       Enter the physical address or a description of the physical
       address in the Home Address area of the Contact Section.
       Route and PO Box numbers should only be entered in the
       Mailing Address area.
       The Method of Contact is a required entry that is used to
       produce the recertification list and letters.
       The address entry screens include read only ZIP+4 fields
       that are populated if the address fields are updated with the
       validated address information. Otherwise, the ZIP+4 fields
       will be empty.

Household Contact Section of the Household Page




                                     The Mailing Address is only
                                     required if it is different from
                                     the Home Address.




      Client address validation does NOT verify that a client
      resides at a particular address. Validation does ensure that
      an address is a deliverable address formatted to USPS
      specifications.
      The ZIP code fields may be left blank when updating the
      addresses. The validation inquiry will return valid ZIP codes
      if the validation is successful and the USPS validated
      addresses are used to populate the address fields.

Validation will occur automatically when Update Contact
Information is selected.




                       4 - 26
     Household Contact Section of the Household Page




                                                        Select Use USPS
                                                        Address Information to
                                                        update the household
                                                        contact information




            The results of the validation will appear in a table above the
            Contact Information table.
            A red check mark will appear next to the Home and/or
            Mailing Address titles if the validation was successful.
            Error and warning messages will be displayed above the
            associated address entry.

     Select                                         to populate the contact
     information fields with the validated address information.

4.7.10 Household Questions

     Click on the              hyperlink or use the browser’s scroll bar
     to locate the Household Questions section on the Household page.


                             4 - 27
 Household Questions Section of the Household Page




Procedures for Establishing Presumptive Eligibility

  A client seeking medical services has an immediate medical need
  that prevents completion of the screening process

      Submit the client information including the complete number of
      family members and the total family income using the
      Eligibility function in SIEBRS
         The client is not eligible for SDI PE services if the family
         income exceeds the maximum allowed or the client has
         outpatient insurance
         If the client is eligible for PE services
                  Set the earliest possible appointment date for the
                  client to return and complete the screening
                  processing
                  When the client returns, use the original PE client
                  record to create a single household that includes all
                  household members
                  Screen the complete household
                  If the client screens ineligible for full SDI or receives a
                  referral to Medicaid/CHIP
                          PE will continue up to a maximum of 90 days
                          each fiscal period to complete treatment and if



                           4 - 28
                     referred to Medicaid/CHIP, provide services
                     pending Medicaid/CHIP eligibility determination
             If the client screens eligible for full SDI
                     Presumptive Eligibility will be terminated and
                     one year of SDI eligibility will be established

A client seeking medical services has an immediate medical need
with the documentation necessary to complete the screening
processing

      Create a single household that includes all household
      members and indicate that the client has an immediate
      medical need using the household screening questions
      Screen the complete household
            If the client screens potentially eligible for
            Medicaid/CHIP
                    Presumptive Eligibility will be established to
                    provide treatment pending Medicaid/CHIP
                    eligibility determination
            If the client screens ineligible for any other reason,
            such as income or private insurance
                    The client is not eligible for SDI services,
                    including Presumptive Eligibility


Mark the applicable questions by clicking in the corresponding
check box     and then select                                 to
associate the questions with specific household members.
Select                                       to save the information.




                        4 - 29
             Household Question Information Page




       Click on the                hyperlink to return to the Household
       page.
4.7.11 Screen Household
Click on the                       hyperlink at the top of the Household
page or the                      button at the bottom of the Household
page to initiate the screening process
                                                           Click on “Screen
                          Household Page                   Household” to initiate
                                                           the screening process.




                               4 - 30
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4.7.12 Automatic Eligibility Terminations

            If a client in the household who is currently SDI eligible is
            determined ineligible by the latest screening, the client’s SDI
            eligibility will be terminated and the Eligibility Terminations
            notification page will be displayed.

               Eligibility Terminations Page




      Select                              to resume screening.

4.7.13 Screening Referral Information

   No SDI Eligibility

               The Screening Referral Information page will be displayed
               with the                     command if no members of the
               household are eligible for SDI services.




                              4 - 32
         Screening Referral Information Page




                              No clients in the household
                              were eligible for SDI services.




Select                       to display the Notice of Ineligibility letter.
Print the letter using the browser’s print function      .




                        4 - 33
Notice of Ineligibility Page




          4 - 34
      Use the browser’s back button      to return to the Household page.

4.7.14 SDI Eligibility

             The Screening Referral Information page will be displayed
             with the                             command if at least
             one member of the household is potentially eligible for SDI
             services.

              Screening Referral Information Page




                                  At least one client in the
                                  household is eligible for
                                  SDI services.




      Print the Screening Referral page using the browser’s print function
           and then select                                .

4.7.15 Documentation
      Verify that the documentation provided by the client meets SDI
      requirements for identification, income and residency by clicking on
      the appropriate check boxes        .
      Select                                            to save the
      information.

                              4 - 35
                     Documentation Page




                                                             Identification
                                                             verification


                                                             Income
                                                             verification



                                                             Residency
                                                             verification


                                                             SDI eligibility
                                                             start date



                                                             Save the
                                                             documentation
                                                             information before
                                                             continuing the
                                                             eligibility process.




Self Declaration

             The Self Declaration Form may be used if a client does not
             have the required documentation.
      Select                           to display the form.




                             4 - 36
                  Self Declaration Page




   Print the form using the browser’s print function   and then use
   the browser’s back button     to return to the Documentation page.

Rights and Responsibilities
   Select                                               and use the
   browser’s print function to print the document. This step must be
   completed before the eligibility letter can be displayed.




                          4 - 37
   Rights and Responsibilities Page

After the form is signed, click on the SDI
Eligibility link to make the clients SDI eligible.




After the form is signed, click on the SDI
Eligibility link to make the clients SDI eligible.




                   4 - 38
4.7.18 Make Clients SDI Eligible
      After the client and SAM sign the Rights & Responsibilities form,
      click on the               link at the top or bottom of the R&R page to
      create the SDI eligibility segments and display the Letter of
      Eligibility page.

              A warning message is displayed if an attempt is made to exit
              the R&R page without clicking on the             link.




              Optionally, use the browser’s back button       to return to the
              Documentation page and select
                                                           to create an SDI
              eligibility segment and display the Letter of Eligibility page.




                               4 - 39
                    Letter of Eligibility and/or Notice of Ineligibility Page



After the Eligibility letter is
printed, click on the SDI
Household link to return to
the Household page.




                                  After the Eligibility letter is
                                  printed, click on the SDI
                                  Household link to return to
                                  the Household page.

                                                   4 - 40
                Print the form using the browser’s print function           and then click
                on the                 link to return to the Household page.
                        After a household has been screened, the latest Referral
                        letter, latest Eligibility letter and screening information are
                        available from the page header in the Household page.

                                     Household Page


Latest                                                                             Screening
Referral                                                                           history
letter



                                   Latest Eligibility Letter




           4.7.19 Screening Information

                Select                        from the page header in the Household
                Page.
                         The screening history identifies the date, time and user
                         identifier of each eligibility screening and each client record
                         modification.




                                          4 - 41
                            Screening History Page




             Select                    to exit the Screening History page and
             return to the Household page.

4.8   Eligibility
      The Eligibility section of SIEBRS is used to enroll individual clients for the
      Confidential Teen, Presumptive Eligibility, Limited Services and Family
      Planning Only eligibility types and to terminate SDI eligibility.

             Select           from the SIEBRS main menu.




                                      4 - 42
                         SIEBRS Main Menu




 4.8.1 Presumptive Eligibility
The Presumptive Eligibility section allows the addition of an eligibility
segment for a new or existing client with an immediate medical need and
who is unable to complete the screening and eligibility process.


   Procedures for Establishing Presumptive Eligibility

      A client seeking medical services has an immediate medical need
      that prevents completion of the screening process

          Submit the client information including the complete number of
          family members and the total family income using the
          Eligibility function in SIEBRS
             The client is not eligible for SDI PE services if the family
             income exceeds the maximum allowed or the client has
             outpatient insurance
             If the client is eligible for PE services
                      Set the earliest possible appointment date for the
                      client to return and complete the screening
                      processing
                      When the client returns, use the original PE client
                      record to create a single household that includes all
                      household members
                      Screen the complete household
                      If the client screens ineligible for full SDI or receives a
                      referral to Medicaid/CHIP



                               4 - 43
                        PE will continue up to a maximum of 90 days
                        each fiscal period to complete treatment and if
                        referred to Medicaid/CHIP, provide services
                        pending Medicaid/CHIP eligibility determination
                If the client screens eligible for full SDI
                        Presumptive Eligibility will be terminated and
                        one year of SDI eligibility will be established

A client seeking medical services has an immediate medical need
with the documentation necessary to complete the screening
processing

         Create a single household that includes all household
         members and indicate that the client has an immediate
         medical need using the household screening questions
         Screen the complete household
               If the client screens potentially eligible for
               Medicaid/CHIP
                       Presumptive Eligibility will be established to
                       provide treatment pending Medicaid/CHIP
                       eligibility determination
               If the client screens ineligible for any other reason,
               such as income or private insurance
                       The client is not eligible for SDI services,
                       including Presumptive Eligibility



Select                             from the Eligibility menu.

                  Eligibility Menu Page




         Select                   to add a new client with Presumptive
         Eligibility.
         Select                      to add a Presumptive Eligibility
         segment to an existing client who does not have a current
         SDI eligibility segment.


                          4 - 44
             Presumptive Eligibility Selection Page




Creating a New Presumptive Eligibility Client

      Select                      to create a new Presumptive Eligibility
      client.
      Enter the demographic, contact, income and eligibility information
      and then select                                        to create the
      eligibility segment.
               The Patient Identifier is an optional field that may include a
               proprietary identification number that will be associated with
               this client record.
               Clients who have outpatient insurance are not eligible for
               SDI Presumptive Eligibility services.
               WHP Status (Yes, No, Denied) refers to the Medicaid
               Women's Health Program and is only required for female
               clients.




                              4 - 45
New Presumptive Eligibility Page




            4 - 46
      Enter the physical address or a description of the physical
      address in the Home Address area of the Contact Section.
      Route and PO Box numbers should only be entered in the
      Mailing Address area.
      The Client Contact Information area includes read only
      ZIP+4 fields that are populated if the address fields are
      updated with the validated address information. Otherwise,
      the ZIP+4 fields will be empty.
      Client address validation does NOT verify that a client
      resides at a particular address. Validation does ensure that
      an address is a deliverable address formatted to USPS
      specifications.
      The ZIP code fields may be left blank when updating the
      addresses. The validation inquiry will return valid ZIP codes
      if the validation is successful and the USPS validated
      addresses are used to populate the address fields.

Validation will occur automatically when Update Contact
Information is selected.

         New Presumptive Eligibility Page



                                                       Select Use
                                                       USPS Address
                                                       Information to
                                                       update the
                                                       client's contact
                                                       information.




      The results of the validation will appear in a table above the
      Contact Information table.
      A red check mark will appear next to the Home and/or
      Mailing Address titles if the validation was successful.
      Error and warning messages will be displayed above the
      associated address entry.


                       4 - 47
Select                                         to populate the contact
information fields with the validated address information.

After successfully adding a new client with Presumptive Eligibility,
the                                          and
                                            hyperlinks are displayed
at the top of the page. These links will allow the Presumptive
Eligibility Letter to be accessed and printed.

            Presumptive Eligibility Page




       The Presumptive Eligibility Letter must be signed and dated
       by both the Service Access Manager (SAM) and the client.
       The original letter must be filed in the client’s record.




                        4 - 48
                                  Presumptive Eligibility Letter




Use the Presumptive
Eligibility hyperlink to return
to the Presumptive Eligibility
selection page.




                                             4 - 49
      Use the browser’s print function       to print the Presumptive
      Eligibility Letter and then use the                      hyperlink
      located at the top of the page to return to the Presumptive Eligibility
      selection page.

Adding Presumptive Eligibility for an Existing Client

      Enter part or all of the client’s name in LAST,FIRST MIDDLE
      format and select                        to retrieve a list of clients that
      match the search parameter.


             Presumptive Eligibility Selection Page




               Click on the client name to add presumptive
               eligibility for an existing SDI client.

      Click on the                    to retrieve the client record.
      Enter the eligibility information and then select
                                   to create a Presumptive Eligibility
      segment for the existing client.
             A household includes all persons who occupy a housing unit
             regardless of their relationship. The Contact information
             must be reentered if the client was removed from an existing
             household.




                                4 - 50
   Existing Client Presumptive Eligibility Page




                               Click on the Client Contact
                               link to add or update
                               contact information




After successfully adding an existing client with Presumptive
Eligibility, the                                           and
                                               hyperlinks are displayed
at the top of the page. These links will allow the Presumptive
Eligibility Letter to be accessed and printed.
        The Presumptive Eligibility Letter must be signed and dated
        by both the Service Access Manager (SAM) and the client.
        The original letter must be filed in the client’s Medical record.




                         4 - 51
                   Presumptive Eligibility Page




       Use the browser’s print function        to print the Presumptive
       Eligibility Letter and then use the                       hyperlink
       located at the top of the Presumptive Eligibility Letter page to return
       to the Presumptive Eligibility selection page.

4.8.2 Confidential Teen
All Confidential Teen clients are eligible for prenatal services. Confidential
Teens are also eligible for Family Planning services if a provider is
contracted to deliver Title X services.

      Select                            from the Eligibility menu.

                       Eligibility Menu Page




                               4 - 52
            Select                    to add a new Confidential Teen
            client.
            Select               to retrieve an existing Confidential Teen
            record.

               Confidential Teen Selection Page




Creating a New Confidential Teen Record

     Select                   to add a new Confidential Teen client.
     Enter the demographic, contact, income and eligibility information
     and then select                          to create the eligibility record.
            The Patient Identifier is an optional field that may include a
            proprietary identification number that will be associated with
            this client record.
            Enter the physical address or a description of the physical
            address in the Home Address area of the Contact Section.
            Route and PO Box numbers should only be entered in the
            Mailing Address area.




                              4 - 53
            New Confidential Teen Page




After successfully adding a new Confidential Teen client, the
                                             hyperlink is displayed at
the top of the page. This link will allow the Confidential Teen
Eligibility Letter to be accessed and printed.


                        4 - 54
Confidential Teen Management Page




The Confidential Teen Eligibility Letter must be signed and
dated by both the Service Access Manager (SAM) and the
client. The original letter must be filed in the client’s record.




                  4 - 55
                       Confidential Teen Eligibility Letter Page



Use the Confidential
Teens hyperlink to
return to the
Confidential Teens
selection page.




                                       4 - 56
       Use the browser’s print function       to print the Confidential Teen
      Eligibility Letter and then use the                    hyperlink
      located at the top of the page to return to the Confidential Teens
      selection page.

Modifying an Existing Confidential Teen Record

      Enter part, or all, of the client’s name in LAST,FIRST MIDDLE
      format then select                  to retrieve a list of Confidential
      Teens that match the search parameter.
                Confidential Teen Selection Page




             Click on the client name to
             retrieve information on an existing
             Confidential Teen client.

      Click on the                    to access and modify an existing
      Confidential Teen record.
             The Confidential Teen management page includes four
             sections:
                     Client Information
                     Contact Information
                     Income Information
                     Termination and Eligibility Functions
      Use the intra-page hyperlinks in the heading of each section or the
      browser’s scroll bar to access the various sections of the
      Confidential Teen Management page.
               The Patient Identifier is an optional field that may include a
               proprietary identification number that will be associated
               with this client record.
               Enter the physical address or a description of the physical
               address in the Home Address area of the Contact Section.
               Route and PO Box numbers should only be entered in the
               Mailing Address area.



                                4 - 57
Confidential Teen Management Page




             4 - 58
       After updating the applicable information, click on the
       hyperlink to return to the Confidential Teens Selection page or the
                     hyperlink to access the Services entry function.

4.8.3 Limited Services
The Limited Services category is for those clients who are in need of
specific services and who do not meet the criteria for full SDI eligibility.

       Select                            from the Eligibility menu.




                                4 - 59
                           Eligibility Menu




             Select                        to create a new Limited Services
             client record.
             Select                        to create a Limited services
             eligibility record for an existing SDI client.
             Select                                to access an existing
             Limited Services client record.

                Limited Services Selection Page




Creating a New Limited Services Client Record

      Select                      to create a new Limited Services client
      record.
      Enter the demographic, contact and eligibility information and then
      select                         to create the eligibility segment.
             The Patient Identifier is an optional field that may include a
             proprietary identification number that will be associated with
             this client record.
             Enter the physical address or a description of the physical
             address in the Home Address area of the Contact Section.
             Route and PO Box numbers should only be entered in the
             Mailing Address area.




                              4 - 60
                Limited Services New Client Page




      Use the                       hyperlink to return to the Limited
      Services selection page.


Adding Limited Services Eligibility for an Existing SDI Client

      Select                         to establish Limited Services eligibility
      for an existing client.
      Enter part, or all, of the client’s name in LAST,FIRST MIDDLE
      format then select                                to retrieve a list of
      clients who match the search parameter.




                               4 - 61
      Limited Services Existing Client Page




     Click on the client name to
     retrieve the client record.




Click on the                  to retrieve the client record.

      Limited Services Existing Client Page
                                                      Any current
                                                      eligibility, other
                                                      than Limited
                                                      Services, must be
                                                      terminated before
                                                      adding a new
                                                      eligibility period.




       SDI clients may only have one current eligibility segment and
       may only have current eligibility in a single household. Any
       current eligibility must be terminated before adding Limited
       Services Eligibility.
If necessary, enter the termination information then select
                       to terminate any current SDI eligibility.
Enter the Limited Services eligibility start date and select
                         to create a new eligibility segment.


                       4 - 62
      Use the                      hyperlink to return to the Limited
      Services selection page.

Modifying an Existing Limited Services Client Record

      Enter part, or all, of the client’s name in LAST,FIRST MIDDLE
      format and then select                              to retrieve a list
      of existing Limited Services Clients.
             Limited Services Existing Client Page




     Click on the client name to
     retrieve the client record.


      Click on the                    to access and modify an existing
      Limited Services record.
             The Limited Services management page has three sections:
                     Client Information
                     Contact Information
                     Termination and Eligibility Functions
      Use the intra-page hyperlinks in the heading of each section or the
      browser’s scroll bar to access the various sections of the Limited
      Services Management page.
             The Patient Identifier is an optional field that may include a
             proprietary identification number that will be associated with
             this client record.
             Enter the physical address or a description of the physical
             address in the Home Address area of the Contact Section.
             Route and PO Box numbers should only be entered in the
             Mailing Address area.




                              4 - 63
Limited Services Client Management Page

                                          The intra-page
                                          hyperlinks may be used
                                          to access the various
                                          sections of the
                                          Management screen.




                4 - 64
      After updating the applicable information, click on the
                                     hyperlink to return to the Limited
      Services Selection page or the                hyperlink to access the
      Services entry function.

4.8.4 Family Planning Only
The Family Planning Only eligibility type provides family planning services
to clients from 0 to 250% of FPIL and is only available to providers who
are contracted to deliver Title X services.

      Select                                      from the Eligibility menu.




                        Eligibility Menu Page




               Select                           to add a new Family Planning
               client.
               Select                         to create a Family Planning
               only record for an existing SDI client.
               Select                       to access an existing Limited
               Services client record.

                  Family Planning Selection Page




Creating a New Family Planning Record

      Select                            to add a new Family Planning client.

                               4 - 65
Enter the demographic, contact, income and eligibility information
and then select                          to create the eligibility record.
       The Patient Identifier is an optional field that may include a
       proprietary identification number that will be associated with
       this client record.
       Enter the physical address or a description of the physical
       address in the Home Address area of the Contact Section.
       Route and PO Box numbers should only be entered in the
       Mailing Address area.




                         4 - 66
New Family Planning Client Page




            4 - 67
After successfully adding a new Family Planning client, the
                                   hyperlink is displayed at the top of
the page. This link will allow the Family Planning Eligibility Letter to
be accessed and printed.

          New Family Planning Client Page




       The Family Planning Eligibility Letter must be signed and
       dated by both the Service Access Manager (SAM) and the
       client. The original letter must be filed in the client’s record.




                         4 - 68
                        Family Planning Eligibility Letter Page




Use the Family
Planning hyperlink
to return to the
Family Planning
selection page.




                Use the browser’s print function      to print the Family Planning
               Eligibility Letter and then use the               hyperlink located at
               the top of the page to return to the Family Planning selection page.

        Adding Family Planning Eligibility for an Existing Client

               Select                            from the Family Planning selection
               page.



                                       4 - 69
           Family Planning Selection Page




Enter part or all of the client’s name in LAST,FIRST MIDDLE
format and select                          to retrieve a list of clients
that match the search parameter.


     Family Planning Add Existing Client Page




Click on the client name to add
Family Planning eligibility for an
existing SDI client.

Click on the                    to retrieve the client record.
Enter the eligibility information and then select
                             to create a Presumptive Eligibility
segment for the existing client.
       A household includes all persons who occupy a housing unit
       regardless of their relationship. The Contact information
       must be reentered if the client was removed from an existing
       household.




                         4 - 70
    Existing Client Presumptive Eligibility Page




                                    Click on the Client Contact
                                    link to add or update
                                    contact information




After successfully adding a new client with Family Planning
Eligibility, the                                    hyperlink will be
displayed at the top of the page. This link will allow the Family
Planning Letter to be accessed and printed.
        The Family Planning Eligibility Letter must be signed and
        dated by both the Service Access Manager (SAM) and the
        client. The original letter must be filed in the client’s Medical
        record.




                         4 - 71
            Family Planning Existing Client Page




      Use the browser’s print function      to print the Family Planning
      Eligibility Letter and then use the               hyperlink located at
      the top of the Family Planning Letter page to return to the Family
      Planning selection page.

Modifying an Existing Family Planning Record

     Enter part, or all, of the client’s name in LAST,FIRST MIDDLE
     format then select                         to retrieve a list of Family
     Planning clients that match the search parameter.




                               4 - 72
          Family Planning Selection Page




 Click on the client name to
 retrieve information on an
 existing Family Planning client.

Click on the                    to access and modify an existing
Family Planning client record.
       The Family Planning management page includes four
       sections:
               Client Information
               Contact Information
               Income Information
               Termination and Eligibility Functions
Use the intra-page hyperlinks in the heading of each section or the
browser’s scroll bar to access the various sections of the Family
Planning Client Management page.
         The Patient Identifier is an optional field that may include a
         proprietary identification number that will be associated
         with this client record.
         Enter the physical address or a description of the physical
         address in the Home Address area of the Contact Section.
         Route and PO Box numbers should only be entered in the
         Mailing Address area.




                        4 - 73
Family Planning Client Management Page




               4 - 74
      After updating the applicable information, click on the
      hyperlink to return to the Family Planning Selection page or the
                    hyperlink to access the Services entry function.
4.8.5 Terminating SDI Eligibility
The SDI Eligibility Termination function is used to terminate current SDI
eligibility.

       Select                          from the Eligibility menu.


                              4 - 75
                     Eligibility Menu




Enter part, or all, of the client’s name in LAST,FIRST MIDDLE
format then select                       to retrieve a list of clients who
match the search parameter.
Click on the                      to retrieve eligibility information on an
existing SDI client.




                          4 - 76
       Eligibility Termination Selection Page




     Click on the client
     name to retrieve
     information on an
     existing SDI client.



Enter the termination reason, termination date and then select
                     to terminate the eligibility segment.
          SDI Eligibility Termination Page




Click on the             hyperlink to return to the Eligibility
Termination Selection page.




                        4 - 77
4.9   Service Codes
      The Service Codes function is used to create and maintain a list of service
      and pharmaceutical codes along with the associated customary charge
      information for use in the Services entry function. There is a single list per
      contractor that is shared by all of the clinics associated with that
      contractor.

             Select                  from the SIEBRS main menu.

                               SIEBRS Main Menu




                      The                           command limits the services
                      displayed in the Service Codes list and menu operated
                      Services entry pages to those payable by a specific funding
                      source.
                      The                          command allows the retrieval of
                      procedures by numeric code or text description and displays
                      a list of the codes that meet the search parameter.
                      Laboratory tests and Dental services are included in the
                      procedure code list.
                      The                          command displays a list of the
                      reimbursable codes for a specific service type.
                      The                          command allows the retrieval of
                      pharmaceutical codes by numeric code or text description
                      and displays a list of the codes that meet the search
                      parameter.
                      SDI does not reimburse for pharmaceuticals classified
                      as over-the-counter by the FDA. The SIEBRS
                      pharmaceutical list does not include pharmaceuticals
                      classified as over-the-counter by the FDA. It is the


                                      4 - 78
       contractor’s responsibility to ensure that a
       pharmaceutical is reimbursable by SDI before issuing a
       prescription to an SDI eligible client.


          SDI does not reimburse Title V contractors for
          laboratory services that are processed by a DSHS
          laboratory free of charge. The applicable laboratory
          services are grayed out on the service code selection
          screens.
          Each service type included in SIEBRS covers a fixed
          set of services. The service code list displays an
          indicator that specifies which service type includes that
          service in its service array. An X in the service type
          column indicates that the service is included. The
          services covered by Primary Health Care are not
          included since the PHC service array includes the
          services covered by all other service types.

To limit codes by funding source, place a check in the check box
next to the funding sources that your agency is contracted to deliver
and then select                          .
To add a procedure or pharmaceutical, enter at least three
characters in the search parameter text field and select the
command button immediately to the right of the text field.
       Any item that includes the search parameter in any portion of
       the code or text description is included in the search results.
       If more than 25 items match the search parameter a
       Continue button will be displayed at the bottom of the page.
       Select             to display additional items that match the
       search parameter.
To add by Service Type, use the pop-up menu to select the service
type and then select                          .




                        4 - 79
         Service Code Management Page

                                                      Laboratory and
                                                      Dental services are
                                                      included in the
                                                      Clinical Procedure
                                                      listing




                        Example: An X in the CH
                        column indicates that the
                        Child Health service type
                        reimburses for this service



Click on the hyperlinked procedure or pharmaceutical code to add
the item to the service code list.




                      4 - 80
Click on the hyperlinked
clinical or pharmaceutical      Service Code Selection Page
code to add the service




                           The SIEBRS system reimburses clinical procedures at the
                           lesser of the contractor’s customary charge or the Medicaid
                           reimbursement rate. The customary charge represents the
                           contractor’s usual and customary charge for a single unit of
                           service.
                           The customary charge information is used to populate the
                           service entry form and to determine an appropriate
                           reimbursement rate.
                    Enter the customary charge in the text field and select
                                      to add the item to the service code list.

                              Customary Charge Editing Page




                    The Service Code menu includes a function to modify the
                    customary charge for any service already included in the service
                    code list. To use this feature, select the applicable code using the
                    pop-up code list and then select                          .
                    To remove an item from the list, select the applicable code using
                    the pop-up code list and then select                          .




                                            4 - 81
                       Service Code Management Page

                   Pop-up service            Select the code using
                   code list                 the pop-up list then
                                             select Remove Service
                                             Entry to delete               Select the code
                                                                           using the pop-up
                                                                           list then select
                                                                           Edit Customary
                                                                           Charge to modify




4.10   Diagnosis Codes
       The Diagnosis Codes function is used to create and maintain a list of
       diagnosis codes for use in the Services entry function. There is a single
       list per contractor that is shared by all of the clinics associated with that
       contractor.

              Select                   from the SIEBRS main menu.




                                       4 - 82
                 SIEBRS Main Menu




To add a diagnosis to the diagnosis list, enter at least three
characters in the search parameter text field and select
                          .
       Any item that includes the search parameter in any portion of
       the code or text description is included in the search results.
       If more than 25 items match the search parameter a
       Continue button will be displayed at the bottom of the page.
       Select to display additional items that match the search
       parameter.

        Diagnosis Code Management Page




                                        Enter at least three
                                        characters of the
                                        code or description
                                        and select Add
                                        Diagnosis Entry



Click on the hyperlinked diagnosis code to add the item to the
diagnosis list.




                        4 - 83
                       Diagnosis Code Selection Page




             To remove an item from the list, select the applicable code using
             the pop-up code list and then select                          .

                     Diagnosis Code Management Page
           Pop-up diagnosis code list




                                               Select the code using the pop-
                                               up list then select Remove
                                               Diagnosis Entry to delete
4.11   Service Entry
       The Services section of SIEBRS is used to enter services for payment and
       to recoup previously paid services.

                    It is the contractor’s responsibility to ensure that a client
                    has SDI eligibility before delivering services with the
                    expectation that SDI will reimburse for those services.
                    SDI will not backdate eligibility or reimburse for services
                    for any period where a client does not have SDI
                    eligibility established in the automated system.
             Select            from the SIEBRS main menu.




                                    4 - 84
                        SIEBRS Main Menu




      Enter part or all of the client’s name in LAST,FIRST MIDDLE
      format then select                 to retrieve a list of clients who
      match the search parameter.
      Click on the hyperlinked                       to retrieve the client
      record.

              Service Entry Client Selection Page




                Click on the hyperlinked
                client name to retrieve the
                client record



4.11.1 Service Entry Functions

             Select                                 to add new client
             services using the code selection menus.
             Select                                 to add new client
             services without using the code selection menus.


                               4 - 85
                               Select                                  to recoup previously
                               paid services.
                               Select                                  to perform client
                               inquiry by date of service.
                      The diagnosis and service code menus can be sorted numerically
                      by code or alphabetically by description. The sort preference is
                      enabled by selecting the radio button       immediately to the left of
                      the corresponding caption. Each users preference is stored and
                      becomes the default setting on subsequent accesses.
                      The                  option inserts the current date into the service
                      delivery date field that appears on the Diagnosis Selection page.
                      Select the checkbox        immediately to the left of the caption to
                      insert the current date.
                      The                  option includes the Patient Identifier field in the
                      service entry screens. Select the checkbox         immediately to the
                      left of the caption to include the current date. The selection is
                      stored and becomes the default setting on subsequent accesses.


             4.11.2     Service Entry Using the Code Selection Menus

                      Select                                    to add new client services
                      using the code selection menus.

                             Service Entry Function Selection Page



Click on the
radio button to
sort the
diagnosis and
service code
menus


                      Enter the Service Date and select the Service Type using the pop-
                      up menu. Select one or more diagnosis entries to be associated
                      with the service entries. Up to nine diagnoses may be selected.
                             The pop-up calendar may be used to populate the service
                             date field.
                             The service types available will depend on the client’s
                             eligibility type, the contractor funding sources and the Title V
                             service types identified on the SDI Budget Form.




                                               4 - 86
                       To select items from a multi-select list box, hold down the
                       Control key and select each item to be included by clicking
                       on it with the mouse. Clicking on the same item a second
                       time will deselect that item. Use the mouse to move the
                       scroll tab up or down to view other items for selection.
                       Dental services do not require a diagnosis entry.
               The Limit Codes by Service Type option limits the billable
               services to those available for a specific funding source and service
               type. For example, if the service type is Child Health and the
               contractor has Title V MCH funding, only services reimbursable by
               Title V MCH Child Health will be available for selection in the
               Service Selection page.
                       The funding sources selectable in the Service Codes
                       section of SIEBRS have a direct effect on the services
                       available for selection in the Services entry section. See
                       section 4.9, Service Codes, for a description of this
                       function.

                             Limit Codes by Service Type
                        Funding Sources Selected in Service Codes Section
Service Type
Selected in             PHC       Title X/XX    Title V FP   Title V MCH    TB
Service Entry
Child Health             X                                        X
Dental                   X                                        X
Dysplasia                X                                        X
Family Planning          X            X             X
Prenatal                 X                                        X
Tuberculosis             X                                                       X
Other                    X                          X



               Select             to access the service selection menu.




                                       4 - 87
             Diagnoses Selection Page




       Pop-up calendar




       The Family Planning Annual Report Information page will be
       displayed if the provider is contracted to deliver Title X
       Family Planning services
Select the Contraceptive Method, Reason if no Method, Method if
Rely on Male Method and Level of Practitioner using the
corresponding pop-up lists and select               to access the
service selection menu.
       Method if Rely on Male Method is only applicable to
       female clients and will not be displayed for male clients.
       Selecting the Set Default check box       will store and use
       the current Level of Practitioner information for each user for
       each subsequent access of the FPAR page.

          FPAR Report Information Page




                        4 - 88
The service menu includes one or more indicators that identify the service
type that reimburses for that service. The Other service type is not
identified since it includes all of the services covered by all of the Other
service types.

           Select one or more service items using the multi-select list box. Up
           to 30 service items may be selected for each billing submission.
                  To select items from a multi-select list box, hold down the
                  Control key and select each item to be included by clicking
                  on it with the mouse. Clicking on the same item a second
                  time will deselect that item. Use the mouse to move the
                  scroll tab up or down to view other items for selection.
           Select              to access the service entry editing page.

                          Service Selection Page




    [FP] indicates that the Family Planning
    service type reimburses for this service




                  There are two commands at the bottom of the editing page
                  that control the editing process.
                                               runs the service entries through
                         the editing process without saving the results. This
                         action does not submit claims for payment.
                                                       stores the service entries
                         along with any remaining editing errors.

                                   4 - 89
Enter the diagnosis relationship number in the Diag column of the
service item table. These numbers must correspond with the
numbers in the diagnosis table above the service item table. Up to
4 diagnoses relationship numbers may be entered for each service
item. The relationship number defaults to 1 if there is only one
diagnosis.
The units entry in the Units column of the service item table
defaults to 1.00. Change this value as appropriate to reflect the
number of units delivered.
        Each service has an established limit on the number of units
        that can be billed for each client for each date of service.
        This information is available in the                  function of
        SIEBRS.
The value in the Customary Charge column of the service item
table defaults to the value entered when the service was added to
the service code list using the                   function of SIEBRS.
This value should represent one unit of service. If the units entry is
changed, the corresponding customary charge should be changed
to correlate with the increased number of units.
The copayment amount is a required entry and must be entered as
0.00 if no copayment was collected.
        Select the checkbox           to the right of the copayment
        text field entry to automatically set the copayment amount to
        0.00 after selecting                       .
        The maximum copayment amount that may be collected will
        be displayed next to the copayment text field after selecting
                              .
Select the check box        in the Rem (Remove) column immediately
to the right of the Service Entry item number and then select
                       to remove a service entry.
        SDI does not reimburse Title V contractors for laboratory
        services that are processed by a DSHS laboratory free of
        charge. The applicable laboratory services are grayed out
        and will return a 0.00 in the Amount column.




                         4 - 90
                                   Service Entry Editing Page


    Duplicate Entry




                                                                        DSHS Lab Service
                   Diagnosis
                   Relationship




                             Maximum Copayment
Remove Entry

                                                                              Zero Copayment




               Subcontractor Office Visit Billing

                      If the service is an office visit or examination, the Subcontractor
                      office visit indicator is displayed. Each client is allowed one
                      contractor and one subcontractor office visit per date of service.
                      Select N for a contractor office visit and Y for a subcontractor office
                      visit.

                                   Service Entry Editing Page



                                         Subcontractor Office Visit




                  On-Site Pharmaceutical Billing

                      If the service is a pharmaceutical, the On-Site Rx field is displayed.
                      This field is used to reimburse contractors who have onsite


                                              4 - 91
pharmacies with a prescription handling charge for dispensing
medications to SDI clients. Using the pop-up list in the On-Site RX
column of the service entry table, select N for pharmaceuticals not
dispensed on-site and Y for pharmaceuticals dispensed on-site.
       SDI does not reimburse for pharmaceuticals classified
       as over-the-counter by the FDA. The SIEBRS
       pharmaceutical list does not include pharmaceuticals
       classified as over-the-counter by the FDA. It is the
       contractor’s responsibility to ensure that a
       pharmaceutical is reimbursable by SDI before issuing a
       prescription to an SDI eligible client.




                       4 - 92
                   Service Entry Editing Page


                     On-Site RX Indicator




Directly Observed Therapy Mileage Billing

       If the service is a DOT/DOPT examination, the DOT mileage field
       is displayed. This field is used to reimburse contractors for miles
       traveled in order to provide an off site DOT examination. Enter the
       miles traveled in mileage format (XX.X). Leave the value as 0.0 if
       no travel was required.

                   Service Entry Editing Page

                             DOT Mileage Value




Family Planning Annual Exam Billing

      If the service is a Family Planning Annual Exam (99203-FP or
      99214-FP) and the contractor is contracted to provide Title X
      services, the Clinical Breast Exam referral field will be displayed.
      Select No for an exam with normal results and Yes for a referral
      resulting from an abnormal exam.

                   Service Entry Editing Page


                        CBE Referral Information




Dental Restoration Billing




                              4 - 93
                   Dental restorations have a different rate for Primary and Permanent
                   teeth. If the service is a dental restoration, the Primary/Permanent
                   tooth designation field will be displayed. Select Prim for a primary
                   tooth and Perm for a permanent tooth.
                          The Duplicate check box will be displayed to the right of the
                          service entry item number to allow the duplication of the
                          restoration entry so that restorations to multiple tooth types
                          may be billed on the same date of service. To duplicate an
                          entry, mark the check box       to the right of the service entry
                          item number and then select                           .


                                Service Entry Editing Page



                                        Dental Restoration
                                        Tooth Type Indicator
Duplicate Service Entry



                   Select                       to run the entries through the editing
                   process. This will identify any errors before submission for
                   payment.
                          A list of error messages preceded by a red ‘X’ is displayed at
                          the top of the page when errors are identified during the
                          editing process. The line number preceding an error
                          message relates to the number preceding the service entry
                          in the service item table.

                                Service Entry Editing Page




                                           4 - 94
The line number
preceding an error
message relates to
the same number in
the service item table




     After correcting any errors, select                           to
     store the claim entries. A confirmation message is displayed at the
     top of the page confirming submission.




                            4 - 95
                   Service Entry Editing Page
                                                      Claim Submission
                                                      Confirmation message




                                                        Reimbursement Amount




       Use the                hyperlink in the page header to select
       another client for service entry. Use the               hyperlink to
       enter additional services for the same client.

4.11.3 Manual Service Entry
Many of the same concepts that are used in the menu driven entry
function apply to the manual entry function. Review that section for
relevant information.

       Select                                from the Service Entry
       Function Selection page to add new client services without using
       the code selection menus.




                              4 - 96
      Service Entry Function Selection Page




       The diagnosis correspondence number in the Diag column
       of the service item table defaults to 1 if there is only one
       diagnosis entered in the Diagnosis table above the service
       item table.
       The units in the Units column of the service item table
       defaults to 1.00.
       The customary charge in the Customary Charge column
       defaults to 0.00 if the service or pharmaceutical code
       entered in the Service/Pharmaceutical column of the service
       item table was not previously selected for inclusion in the
       service code list.
Select                        at the bottom of the Manual entry page.
The diagnosis and service or pharmaceutical descriptions will be
displayed after                        is selected.
       If the service type is Family Planning and the contractor is
       contracted to deliver Title X services, the FPAR information
       fields will be displayed at the top of the screen after selecting
                            .
After correcting any editing errors, select to store the information.
                              A message confirming submission will
be displayed at the top of the Manual entry page.




                        4 - 97
                      Manual Service Entry Page



                                                            The Contraceptive
                                                            Method and Level of
                                                            Practitioner are only
                                                            applicable to Title X
                                                            contractors




         Use the                 hyperlink in the page header to select another
         client for service entry. Use the               hyperlink to enter
         additional services for the same client.

4.11.4     Recouping Payments



                                 4 - 98
The recoupment function allows the contractor to recoup previously
submitted services.

             Recouping a service does not remove the service entry from
             the system. The recoupment process creates a new service
             record with an amount that negates the original entry. When
             the service records are retrieved using the Payments inquiry
             function, both service records will include a status message,
             'CONTRACTOR RECOUPMENT', that will identify the
             services as recouped.
             Each payment is attributed to a specific funding source with
             a corresponding financial account that is maintained by the
             Department's Fiscal Division. The recoupment must be
             attributed to the same account as the original payment. For
             example, if a service was originally paid from the Title
             V/Activity 185 account, the corresponding recoupment must
             be deducted from the TitleV/Activity 185 account. The
             recoupment cannot be deducted from a different account
             maintained for a separate funding source.
             The weekly payment request submitted to the Department's
             Fiscal Division cannot have a net negative value. There must
             be a sufficient amount of payable, unprocessed service
             entries for the applicable funding source to result in a net
             positive value when the amounts of the recovered services
             are deducted from the payable services. The actual payment
             process occurs one time each week, usually Monday
             evening. Services entered from Tuesday morning of one
             week to Monday afternoon of the following week are
             accumulated in the system before being submitted to the
             Fiscal Division for payment processing. The term 'payable,
             unprocessed' refers to this weekly accumulation of service
             entries.
             The Department's Fiscal policies are enforced in the SIEBRS
             automation system. An audit is performed at the time a
             service is submitted for recoupment to determine whether a
             sufficient amount of payable services exists, for the account
             from which the service was originally paid, to offset the
             negative amounts. A system message is displayed, 'There
             are not enough new payments to recoup (service code)',
             if the required payable, unprocessed services are not
             present.
      Select                                  from the Service Entry
      Function Selection page.




                             4 - 99
      Service Entry Function Selection Page




Use the pop-up service date list to select the date of service and
then select                   .

             Service Recoupment Page
    Select the service
    date using the pop-
    up list then select
    Retrieve Services

Use the multi-select list box to identify the services to be recouped
then select                                    to recoup the selected
services.
       To select items from a multi-select list box, hold down the
       Control key and select each item to be included by clicking
       on it with the mouse. Clicking on the same item a second
       time will deselect that item. Use the mouse to move the
       scroll tab up or down to view other items for selection.

             Service Recoupment Page




                                    Select the services to be recouped
                                    then select Recoup Services

       A message is displayed at the top of the page confirming
       recoupment of the selected services.



                       4 - 100
                    Service Recoupment Page




       Use the                hyperlink in the page header to select
       another client for service entry. Use the               hyperlink to
       enter additional services for the same client.

4.11.5 Service History
A client’s service history may be reviewed using the Service History
function.

      Select                                  from the Service Entry
      Function Selection page.


             Service Entry Function Selection Page




      Use the pop-up service date list to select the date of service and
      then select                   .




                              4 - 101
                              Service History Page
                       Select the service
                       date using the pop-
                       up list then select
                       Retrieve Services




                     The Service History display includes diagnosis description,
                     service description and units billed. More comprehensive
                     information is available in the Payments inquiry function of
                     SIEBRS.

                              Service History Page




            Use the                 hyperlink in the page header to select another
            client for service entry. Use the               hyperlink to enter
            additional services for the same client.

4.12   Payment Inquiry

            Select             from the SIEBRS main menu.




                                     4 - 102
                 SIEBRS Main Menu




      The State Fiscal Period, Month of Service, Clinic Name and
      Service Type are global properties that apply to multiple
      inquiry types.
      The State fiscal period runs from 09/01 of one year to 08/31
      of the next year. The fiscal period for 09/01/2005 to
      08/31/2006 is 2006. The period defaults to the current fiscal
      period.
      The Month of Service setting limits the results to a specific
      month within the fiscal period.
      The Clinic setting limits the results to a specific clinic.
      Selecting a blank clinic option displays results for all of a
      contractor’s clinics.
      The Service Type setting limits the results to a specific
      service type. Selecting a blank service type option displays
      results for all service types.
Choose the fields to be displayed in the inquiry results by selecting
the                hyperlink. Place a mark in the check box
below the corresponding field and then select                        .




                       4 - 103
       Payment Inquiry Field Selection Page




Select the fiscal period by using the pop-up list immediately to the
right of the State Fiscal Period caption.
Select the month of service using the pop-up list immediately to the
right of the Month of Service caption.
Select the clinic by using the pop-up list immediately to the right of
the Clinic Name caption.
Select the service type using the pop-up list immediately to the right
of the Service Type caption.
To perform inquiry by                     ,                   or ,
                    enter the search parameter in the text field
immediately following the inquiry type caption and then select the
corresponding command button immediately following the text field.
        To perform inquiry on pharmaceuticals, enter the 11-digit
        NDC code in the Service Code text field and select
                            .
To perform inquiry by client name, enter part or all of the client’s
name in LAST,FIRST MIDDLE format then select
to retrieve a list of clients who match the search parameter. Click
on the hyperlinked                     to return the search results.
The Process Date inquiry type creates a list of the services that
were processed in the weekly claim processing run. Select the
process date using the pop-up list immediately to the right of the
Process Date caption and then select                       .
        Select the Process Date entry with double slashes // at the
        bottom of the process date pop-up to create a list of the
        services that have not been processed for payment.
To perform inquiry on services that have been paid and then
recouped because of Medicaid eligibility, select
                        .




                       4 - 104
Payment Inquiry Selection Page

                         Field Selection




                          The Service Code
                          command is used for
                          procedures and
                          pharmaceuticals




                           Click on the hyperlinked
                           client name to view the
                           inquiry results

         The number of service entries returned in the search results is
         limited. A Continue button will be displayed at the bottom of the
         Results page if the number of entries exceeds the display limit.
         Select              to display additional items that match the search
         parameter.
                The payment total displayed at the top of the page applies to
                the current display. Each page resulting from a single
                inquiry includes the total for that page.
                Error messages appear immediately below the applicable
                service entry.




                                4 - 105
                    Payments Inquiry Results Page

                                                                   The payment total
                                                                   applies to the
                                                                   displayed results

Spreadsheet Hyperlink




                                                                          Error messages
                                                                          appear below the
                                                                          associated entry

          The payment inquiry results include a                         hyperlink
          that will create an XLS file of the displayed results. This file may be
          downloaded and viewed with a spreadsheet application such as
          OpenOffice or Excel.
                 Click on the                      link and then click on the
                 associated file name to download the spreadsheet file.




                                 4 - 106
                          Payments Inquiry Results Page




                                                                 Select the spreadsheet
                                                                 file name to download
                                                                 the XLS file
              Click on the                    hyperlink to the Payments Inquiry
              Selection page.

4.13   Client List
       The Clients area is used to create a customized client list of SDI eligible
       clients using the eligibility period.

              Select           from the SIEBRS main menu.

                                 SIEBRS Main Menu




                       The State Fiscal Period runs from 09/01 of one year to 08/31
                       of the next year. The fiscal period for 09/01/2005 to
                       08/31/2006 is 2006. The period defaults to the current fiscal
                       period.
                       The Eligibility Type setting limits the results to a specific SDI
                       eligibility type. Selecting a blank eligibility type displays
                       results for all eligibility types.
                       The Eligibility Start Month setting limits the results to any SDI
                       eligibility start period that occurs in the selected State Fiscal
                       Period and Eligibility Start Month.



                                       4 - 107
      The Eligibility End Month setting limits the results to any SDI
      eligibility end period that occurs in the selected State Fiscal
      Period and Eligibility End Month.
      The Clinic Name setting limits the results to a specific clinic.
      Selecting a blank clinic option displays results for all of a
      contractor’s clinics.
      The Client Name setting limits the displayed results to SDI
      eligible clients whose name matches the name parameter.
      The Multiple Eligibility option includes all eligibility periods
      that occur in the selected State Fiscal Period.
Choose the fields to be displayed in the inquiry results by selecting
the                 hyperlink. Place a mark in the check box
below the corresponding field and then select                          .

           Client List Field Selection Page




Select the fiscal period by using the pop-up list immediately to the
right of the State Fiscal Period caption.
Select the Eligibility Type by using the pop-up list immediately to
the right of the Eligibility Type caption.

         SDI         Full SDI eligibility
         SDI-PE      Presumptive eligibility
         SDI-CH      CHIP Supplemental
         SDI-CT      Confidential Teen
         SDI-LS      Limited Services
         SDI-FP      Family Planning

Select the Eligibility Start Month by using the pop-up list
immediately to the right of the Eligibility Start Month caption.
       The Eligibility Start Month and Eligibility End Month are
       mutually exclusive. You may only select one or the other,
       but not both.
Select the Eligibility End Month by using the pop-up list immediately
to the right of the Eligibility End Month caption.
       The Eligibility Start Month and Eligibility End Month are
       mutually exclusive. You may only select one or the other,
       but not both.
Select the clinic by using the pop-up list immediately to the right of
the Clinic Name caption.



                        4 - 108
To perform inquiry by Client Name, enter part or all of the client’s
name in LAST,FIRST MIDDLE format.
Mark the check box       to the right of the Multiple Eligibility
Segments caption to include multiple eligibility segments that occur
within the specified State Fiscal Period for the same client.
        Including multiple eligibility segments within the results is
        mutually exclusive of the Eligibility Start Month and Eligibility
        End Month selections. You may select a start or end month
        or include multiple eligibility segments, but not both.
               Client List Selection Page


                          Field Selection

                                                     Start and End
                                                     Months are
                                                     mutually exclusive




                                                  Include multiple eligibility
                                                  segments


       The number of eligibility entries returned in the search
       results is limited. A Continue button will be displayed at the
       bottom of the Results page if the number of entries exceeds
       the display limit. Select                        to display
       additional items that match the search parameter.

               Client List Results Page


The client list results page includes a                      hyperlink
that will create an XLS file of the displayed results that may be
downloaded and viewed with a spreadsheet application such as
OpenOffice or Excel.
       Click on the                      link and then click on the
       associated file name to download the spreadsheet file.




                        4 - 109
                        Payments Inquiry Results Page




                                                               Select the spreadsheet
                                                               file name to download
                                                               the XLS file
             Click on the                           hyperlink to return to the
             Client List Selection page.

4.14   Provider Inquiry
       The Provider area includes information that is of general administrative
       interest. Contact DSHS for assistance if the Provider or Clinic information
       has changed or is incorrect. This information is divided into five sections:
                                 Provider name, address, and contact information.
                    This information is used for the Remittance/Status reports
                    and printable pages that include provider contact
                    information.
                               Includes each clinic’s name, address, and contact
                    information. This information is used for individual clinic
                    affiliation and printable pages that include clinic contact
                    information.
                                  Contract information by funding source including
                    balances expended and remaining.
                                    Copayments reported by fiscal period, month of
                    service and funding source.
                                  - Weekly payment information that includes
                    amount processed and distribution of amount by funding
                    source.

             Select           from the SIEBRS main menu.




                                     4 - 110
                        SIEBRS Main Menu




      Use the intra-page hyperlinks in the heading of each section or the
      browser’s scroll bar to access the various sections of the Provider
      Information page.

4.14.1 Provider Information
The Provider information is used to populate printable pages in SIEBRS
that include provider contact information.

                     Provider Information Page
                                                               The intra-page
                                                               hyperlinks may be
                                                               used to navigate the
                                                               various sections of
                                                               the Provider area




Clinic Information

            The Clinic information is used to populate printable pages in
            SIEBRS that include provider contact information.



                             4 - 111
                 Provider Information Page




4.14.2 Contract Information

           The Amount Submitted, Balance and Copay Submitted fields
           are updated in real time as services are submitted for
           payment. The Amount Submitted for the Title X funding
           source reflects the paper voucher amount submitted for Title
           X payment. The Title X Services amount reflects the amount
           of services submitted through SIEBRS and attributable to
           Title X.

                 Provider Information Page




                          4 - 112
       4.14.3 Copayment Information


                  The co-payments table is updated after 5 p.m. each workday
                  and may not match the Co-pay Submitted field in the
                  Contracts section.

                        Provider Information Page




       4.14.4 Payment Information

                  The Payments section shows the actual amount that was
                  submitted for warrant or direct deposit processing. Payment
                  processing usually occurs one time each week.
                  After the claims are processed by SIEBRS, they are edited
                  against other DSHS payment processing systems. The
                  amounts and processing information displayed in the
                  Provider Information page may change as a result of the
                  additional processing.

                        Provider Information Page




4.15   Reports



                                 4 - 113
The reports are updated each working day at about 5:45 p.m. and include
a Run Date in the report heading that reflects the date of the last report
update.

           Where unduplicated information is being reported and
           multiple records exist within the reporting period, the data
           recorded closest to the end of the reporting period or the
           report run date is used to determine the reporting category.
      Select         from the SIEBRS main menu.

                       SIEBRS Main Menu




      Select the report period using the pop-up list immediately to the
      right of the report caption and then use the command button
      immediately to the right of the pop-up list to access the report.




                             4 - 114
     SIEBRS Reports Menu Page




The Family Planning Annual Report is only produced for
providers who are contracted to deliver Title X services. The
data is derived from the Payments file and only includes the
SDI clients who received a service during the reporting
period that was attributed to the Title X funding source or
reimbursed from the Title XX funding source. DSHS
laboratory services meet the qualification if they were
recorded with a zero amount and include no editing errors.
The FPAR report in SDI only includes SDI clients at or below
185% of the Federal Poverty Guidelines. It is the
contractor’s responsibility to maintain the data necessary for
FPAR reporting if there are non-SDI clients served who meet
the reporting criteria.
The age reported is the client’s age on June 30th of the
reporting period.
The income information that was recorded closest to the end
of the reporting period is used to populate the
UNDUPLICATED NUMBER OF FAMILY PLANNING
USERS BY INCOME LEVEL table.
SDI Chip Supplemental clients are counted in Row 1, Public
health insurance covering primary medical care, in the
UNDUPLICATED NUMBER OF FAMILY PLANNING
USERS BY PRINCIPAL HEALTH INSURANCE COVERAGE
STATUS table. All other SDI clients are counted in Row 5,
Uninsured (no public or private health insurance).


                4 - 115
Clients are counted in the UNDUPLICATED NUMBER OF
FAMILY PLANNING USERS WITH LIMITED ENGLISH
PROFICIENCY (LEP) table if the Needs Interpreter question
is answered affirmatively in SIEBRS.
The number of Pap test performed are included in the
CERVICAL CANCER SCREENING ACTIVITIES table,
however, the Pap tests results are not included. It is the
contractor’s responsibility to collect and report the Pap tests
results.
The number of HIV Confidential Test are included in the
NUMBER OF GONORRHEA, SYPHILIS, AND HIV TESTS
table, however, the number of Positive confidential tests and
Anonymous tests are not included. It is the contractor’s
responsibility to collect and report the number of Positive
Confidential and Anonymous tests.
The following service codes are included in the report
counts:
                                   88150
                                   87205
Pap Tests
                                   88141
                                   88142
                                   99203-FP
Breast Exam
                                   99214-FP
                                   87797
Chlamydia
                                   87490
                                   87797
Gonorrhea
                                   87590
Syphilis                           86592
                                   86701
HIV Tests
                                   86689


The FP All Funding Sources Report is only produced for
providers who are contracted to deliver Title X services. The
report is an unduplicated count of all clients who received a
family planning service reimbursed by any funding source
included in SDI. DSHS laboratory services meet the
qualification if they were recorded with a zero amount and
include no editing errors.
        The report period is the State fiscal year (09/01 to
        08/31)
        The age reported is the client’s age on February 28th
        of the reporting period.




                4 - 116
Family Planning All Funding Sources Page




  The client counts in the Quarterly Eligibility reports are
  unique only within the quarter being reported. The sum of
  the client count values from the Quarterly reports will not
  equate to a year-to-date or annual value. The age used in
  the Quarterly and Annual reports is the client's age on March
  1 of the fiscal reporting period.
          SDI Screening by Clinic, County and Program
          Type
          Each client is counted once and only once to each
          program type screened within the reporting period.
          SDI Eligibility by Clinic, County and Eligibility
          Type
          Each client is counted to one and only one eligibility
          type. The latest eligibility segment in the reporting
          period is used to determine the client's eligibility type.
          SDI Demographics of the Eligible Population
          Age, sex and race distribution of the eligible
          population.
          SDI Income Status of the Eligible Population
          Poverty level distribution of the eligible population.
          The income information recorded closest to the end of
          the reporting period is used to populate the Income
          Status table.



  The age used in the Quarterly and Annual reports is the
  client's age on March 1 of the fiscal reporting period.
          SDI Unduplicated Clients Served by Clinic and
          County
          The client must have received a paid service within
          the reporting period to be included in the unduplicated
          count.


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      SDI Clients Served by Clinic, County and Funding
      Source
      Each client is counted once and only once for each
      funding source. The client must have received a
      service attributed to or reimbursed by the applicable
      funding source within the reporting period to be
      included in that funding source's count.
      The Title V funding source is also unduplicated. The
      client is counted once and only once to the Title V
      funding source. The activity code recorded with the
      latest service date within the reporting period is used
      to determine the reporting category.
      SDI Demographics of the Served Population
      Age, sex and race distribution of the served
      population.
      SDI Income Status of the Served Population
      Poverty level distribution of the eligible population.
      SDI Visits by Clinic and Diagnosis
      A visit is recorded one time for each service date
      where a client received a payable service. The
      primary intent of this report is to obtain the unique
      number of visits as defined by the preceding
      statement, not the number of diagnosis. Therefore,
      the diagnosis of the first recorded payable service on
      each service date is used to categorize the diagnosis.
      Dental services do not require a diagnosis entry. They
      are reported with a code of DENT and a description of
      DENTAL SERVICE.
      SDI Services Delivered by Clinic and Funding
      Source

The Medicaid Client List is a report of the clients who were
entered into SIEBRS and matched a client who is, or was,
eligible for Medicaid on the date of service. The report is
subdivided by clinic. A blank entry in the Eligibility Close
Date field indicates that eligibility is ongoing.




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       Medicaid Client List Page




The Medicaid Non-Recoupments Report is a report of the
clients who received a service reimbursed by SDI and who
were subsequently found to have Medicaid eligibility on that
date of service.
        The report only includes services that have not been
        recouped by the automated system.
        Services are removed from the report as they are
        recouped by the automated system.
MEDICAID NON-RECOUPMENTS PAGE




       The Recertification Client List is produced to assist
       the contractors in identifying clients whose SDI
       eligibility is due to expire within the next month.
       Client re-certifications are optional.


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        In any given month, separate lists are produced for
       the past, current and future months.
       Separate lists are produced for each clinic.
       Households whose members are served at multiple
       clinics are grouped according to the clinic associated
       with the oldest household member.
       The list does not include clients whose SDI eligibility
       was terminated for a reason other than eligibility
       expiration.
       The list does not include clients who were identified
       as having Medicaid eligibility on the SDI expiration
       date.
       The list does not include clients who specified None
       as the Method of Contact.
       The list does not include clients whose eligibility type
       is Presumptive Eligibility or Limited Services.

       Recertification Client List




The Recertification Letters are produced for those clients
who are included in the Recertification List and specified Mail
and Phone or Mail Only as the method of contact.
      Client recertifications are optional.
      Households whose members are served at multiple
      clinics are grouped according to the clinic associated
      with the oldest household member. A single letter is
      produced for each household.
      The letters are designed to be streamed to a printer
      and to print one letter per page.



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Recertification Letters




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Warning: the Federal Poverty Guidelines table used in this
document is an example of the report and should not be
used to determine eligibility.
  Federal Poverty Guidelines Page




The Unfunded Claims report shows the number and
reimbursable amount of claims rejected by SIEBRS because
of a lack of funding.
         A claim is only included if the reason for rejection is
         'Payment would exceed the ... contract amount'.
         Claims with non-funding related errors are not
         included
         The number of services is the number of individual
         line items that have been submitted
         The client count is unique by service type. A client
         will be counted in multiple service type counts if
         billings for multiple service types have been
         submitted


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                             Pharmaceuticals are reimbursed at contractor cost
                             and are not included in the amount
                             The amount is based on the Medicaid rate
                             applicable in the report period and is reduced by
                             2.5%
                             The amount excludes any copayments that would
                             have reduced the reimbursable amount

                           UNFUNDED CLAIMS PAGE




4.16   Maintenance
       The Maintenance section of SIEBRS allows the users to delete clients
       from the automation system and to set their individual clinic affiliation.
       This section also allows a contractor to access the SIEBRS Training
       Provider and include localized referral information on the Screening
       Referral Information page.

              Select                from the SIEBRS main menu.




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                          SIEBRS Main Menu




  4.16.1 Deleting a Client
  The intent of this function is to remove duplicate client entries. Client’s
  who are no longer associated with a household should be moved to a new
  household, not deleted. Clients with payment records cannot be deleted
  from the automated system.

To remove a client from a household:
      Access the individual Client screen by selecting the hyperlinked
                        in the Household Page
       Terminate any current eligibility for the applicable client in the
      old household using the                          function at the
      bottom of the Client screen
      Select                                    at the bottom of the Client
      screen to remove the client from the household
      To create a new household for the client being removed:
      Create a new household using the
      function in the Household Selection screen
      Use the                                   function to move the client
      into the new household
          ✔ When a client is deleted from the system or removed from
              a household, the old and new households must be re-
              screened for continuing SDI eligibility
          ✔ A household includes all persons who occupy a housing
              unit regardless of their relationship. Removing a client
              from a household will remove any existing address
              information for that client



                                 4 - 124
       The individual client screens available from the Household
       Page will also allow a client to be removed from a household
       or deleted from the system if there are no payment records.
Select                        from the Maintenance menu.

                   Maintenance Menu




Enter part, or all, of the client’s name in LAST,FIRST MIDDLE
format and select                   to retrieve a list of clients that match
the search parameter.
Click on the hyperlinked                        to delete the client.
       SDI eligibility is determined using household composition.
       Whenever a client is deleted from the system or removed
       from a household the composition changes and the
       remaining household members must be re-screened for
       continuing eligibility. A ‘Y’ in the Screen field of the client
       listing indicates that the household composition has changed
       and the household must be re-screened.

                   Client Delete Page




    Click on the hyperlinked client
    name to delete the client.




                         4 - 125
              An error message will be displayed at the top of the page if
              the client being deleted has any associated payment
              records. Clients with payment records cannot be deleted
              using the Delete function.
              If the other duplicate client does not have payment records,
              delete the other client.
              If both clients have payment records, contact DSHS for
              assistance with merging and then deleting the client records.

                         Client Delete Page




 Clients with
 payment records
 cannot be deleted
 using the Delete
 function

       Click on the                   hyperlink to return to the Maintenance
       menu page.

4.16.2 Clinic Affiliation
Every SIEBRS user must be associated with a specific clinic. The clinic
information is recorded each time a client record is added or modified and
each time services are submitted for payment. This information is then
used to produce reports with clinic specific results.
              The Clinic Affiliation function is available for contractor staff
              who perform data entry functions for multiple clinics and staff
              who travel between clinics.
       Select                          from the Maintenance menu.




                               4 - 126
                    Maintenance Menu




Use the pop-up list to select the clinic and then select .

       The new clinic affiliation becomes the default clinic for each
       SIEBRS access.

                Clinic Affiliation Page




       Each users current clinic affiliation is displayed on the
       SIEBRS main menu.

                 SIEBRS Main Menu




                 Each users current clinic
                 affiliation is displayed on the
                 SIEBRS Main menu.




                        4 - 127
       Click on the                   hyperlink to return to the SIEBRS
       main menu .

4.16.3 Accessing the Training Provider
The Training Provider is a simulated provider used for development,
testing and training. The Training Provider is available for contractor staff
to use for their own training requirements.

              This option will not be available to DSHS staff from the
              Maintenance Menu since the option is already available from
              the DSHS Menu.
       Select                        from the Maintenance menu.

                           Maintenance Menu




              Each page in the Training Provider area includes the
              Training Provider caption in the top left corner of the page.
              The Training Provider area is available to all SDI
              contractor staff throughout the state, many DSHS staff
              and other third parties for demonstration and training
              purposes. Do not enter confidential client or service
              delivery information in the Training Provider area. If
              information is inadvertently entered, delete the client
              information immediately. Contact DSHS staff for
              assistance if you are unable to delete the information
              because of payment records.




                              4 - 128
                       SIEBRS Main Menu
          Every page in the Training Provider area is
          displayed with the Training Provider label.




      To exit the Training Provider and return to the production area,
      select                       from the Maintenance menu.

                       Maintenance Menu




4.16.4 Referral Information
      Each contractor may optionally include localized agency name,
      telephone and address information on the Screening Referral
      Information page that is generated during the screening process.
      Referral information is available for CHIP, CIHCP, CSHCN,
      Medicaid/TANF and WIC.




                             4 - 129
       The Referral information entered is clinic independent and
       will be included on all Screening Referrals generated for the
       same contractor.
       Multiple referrals for the same program type may be entered
       and will be included on the Screening Referrals Information
       page.
Select                            from the Maintenance menu.

                   Maintenance Menu




 Select the program type using the program selection pop-up and
 enter the localized information for that program type.
       All fields are free form, unedited, text fields that may include
       any type of information such as contact name, email address
       or web site.
Select                              to save the referral information.




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               Referral Information Page




       Screening Referral Information Page




Click on the                 hyperlink to return to the Maintenance
menu page.




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4.17   Notices
       The Notices section of SIEBRS is used to notify the users of significant
       changes or other information regarding the automation system.

             Select           from the SIEBRS main menu.

                              SIEBRS Main Menu




             The Notices page appears automatically when new information is
             added and is subsequently accessible by selecting       from
             the                    .

                                  Notices Page




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Click on the             hyperlink to return to the SIEBRS
main menu.




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