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					                   Basic MMIS
This training was designed to give you the skills to use the
Medicaid Management Information System (MMIS) to view
data about waiver and Alternative Care (AC) recipients or other
individuals who’ve had a preadmission screening.

This course is a prerequisite to hands-on computer training for
entering new screening documents and service agreements or
changing existing documents. You must have a logon ID and
password to complete this training.

While going through this training, you will be asked to perform
tasks in MMIS. These instructions will be shown in bold.
        The following topics will be
                 discussed
•   Security
•   Logging into and out of MMIS
•   Navigation
•   Subsystems

MMIS is a complex, highly integrated claims payment,
information management, and retrieval system implemented
in June, 1994. Every subsystem provides information that is
needed to ensure claims are correctly paid.
Claims that need prior authorization either from the
Department of Human Services or from a county agency are
processed through the Prior Authorization (PA) subsystem.
The following methods are used to obtain the prior
authorization:


• LTC screening document
• DD screening document
• MA home care authorization
• Waiver and Alternative Care service agreements
• Chemical Dependency service agreements
• Medical Assistance dental, medical, pharmacy and
  supplies/equipment authorizations
• Minnesota Pregnancy Assessment Form
                Security - Logon ID
Your logon ID should not be shared with others. On screening
documents and service agreements it is recorded at the top of the
screen when you save changes to an existing or new screening
document or service agreement.
      Security - Changing Passwords
Password changes are completed on the Logon Screen. After
entering your Logon ID number and current password, Tab to the
New Password section and type a different password in the New
Password field. Tab to the final line and retype it again. Press the
Transmit Key.
    Security - Suspended Passwords
If you type the password incorrectly, a message “Password Does Not
Match” will appear. Notify your MMIS security officer to
unsuspend your password. That person will contact DHS.
             Security - Main Menu
The Main Menu Screen controls all the subsystems you are able to
access. If there is a subsystem you need to access that is not shown
on this screen, contact your MMIS security officer in order to be
placed into a different security group.
         Security - Keypanel Screen
This screen controls what actions you can make in the subsystem.
Generally, the actions are Inquiry (to view data), Change (to change
the existing data), Add (to add a new record), and Delete (to
eliminate a record). If you are able to access a subsystem, but do
not have the ability to add, change, or delete, contact your MMIS
security officer in order to be placed into a different security group.
  Security - Additional Restrictions
There are two other types of security restrictions:

1) screens within a subsystem that will not appear for your viewing
and/or

2) data not viewable on a screen
     Logging Into and Out of MMIS
Starting with the “State of Minnesota” screen, type “CICSDVA”.
This is the training region and not the MMIS that you will be
working normally. Press the “Transmit Key” which is either the
right or left hand control key. It can also be the “Enter” Key on the
number pad of the keyboard. You will be brought to the logon
screen.
               The Logon Screen
Type your logon ID number, Tab to the next line and type your
password. Press the Transmit Key to advance to the next screen.
SYSTEM: A00000 WELCOME TO CICS/ESA
           TO EXIT, CLEAR SCREEN AND ENTER "LOGOFF"
  TERMINAL: 1C16
    NODE: L00C1C16

    DAY: WEDNESDAY

SYSTEM DATE: NOVEMBER 22, 2000
SYSTEM TIME: 11:31 AM

  LOGONID: ===>
 PASSWORD: ===>

NEW PASSWORD: ===>
(enter twice) ===>
At the top of this screen (see below) type “MW00" being careful to use
the number zero and not the letter O keys. If you make a mistake, a
message appears at the bottom indicating that it does not recognize what
you just typed. Use your TAB key to move the cursor once to the right
and retype MW00. Then press the Transmit Key to advance to the Main
Menu Screen.


mw00
ACF01137            LAST SYSTEM ACCESS 13.05-11/27/00 FROM L00C2C40
ACFAE139 ACF2/CICS A251 Signon OK: User = 99999999 NAME = LYLE LEVITT
                 Main Menu Screen
The Main Menu Screen will not look the same for everyone.
Depending on your security group, it can contain more or less
subsystems than other people.

When you wish to leave MMIS, use the PF3 or PF6 Key to return to
this screen. Press the key once more to return to the MW00 screen.
Type “Logoff” as one word at the top of the screen and press the
Transmit Key. You are now at the State of Minnesota screen.
                      Main Menu Screen
11/22/00 11:37:02 MMIS MAIN MENU - MAIN PROD DY00 PWMW000
       *** MEDICAID MANAGEMENT INFORMATION SYSTEM ***
            SEL                                         SEL
 CLAIMS PROCESSING APPLICATIONS:            OTHER APPLICATIONS (CONT.):
 INQUIRY                                    TPL RESOURCE FILE APPLICATION
 REFERENCE FILE APPLICATIONS:               RECIPIENT MISCELLANEOUS FUNCTIONS
                                            MANAGED CARE
  PROC, DRUG, DIAG, DRG, UPC
  RATES
  EXCEPTION CONTROL
  TEXT
  SYSTEM PARAMETERS/LIST PARAMETERS
 PRIOR AUTHORIZATION APPLICATIONS:
  PRIOR AUTHORIZATION
  SCREENINGS
 OTHER APPLICATIONS:
  PROVIDER FILE APPLICATION
  RECIPIENT FILE APPLICATION
  TPL BILLING APPLICATION
  MISCELLANEOUS FUNCTIONS
  SECURITY ADMINISTRATION
  FINANCIAL CONTROL
ENTER--PF1---PF2--PF3--PF4---PF5--PF6---PF7--PF8--PF9--PF10---PF11--PF12
              MINI TEST
• What are the steps to enter into MMIS?
• What are the steps to leave MMIS?
• How is your security limited by the Main
  Menu Screen?
• How is your security limited by the
  Keypanel Screen?
• What other restrictions may limit what
  information you may see?
                     Navigation
There are different methods to move the cursor from one place to
another and to advance to a different screen. These methods are
grouped as:

    Moving the Cursor Within a Screen

    Moving Between Screens

    Moving Between Subsystems
            Navigation -
  Moving the Cursor Within a Screen
Home Key - moves the cursor to the top of the page.

Arrow Keys - used while in the Inquiry Action to move the cursor
within the page.

Enter Key - used while in the Add or Change Action to move the
cursor down the page.

Tab Key - used while in the Add or Change Action to move the
cursor across the page.

Shift/Tab Keys - used together while in the Add or Change Action
to back the cursor to the previous field.
Navigation - Moving Between Screens
Transmit Key - will move you to the next screen

Next Field - identifies the name of the screen that will appear
after the current screen. You can type in the name of the screen
you wish to go to and when you use the Transmit Key you will
be brought directly to that screen.

NEXT: RBEN 11/22/00 MMIS RECIP SUMMARY-RSUM 09/30/00 PWMW111
00000000       01/01/1900       * RECIPIENT RECIPIENT ON REVIEW (Y/N): N
Rabbitt       Bunny       * STATUS    TPL POLICY COVERAGE (Y/N): N
**********************************       A   TPL RECOVERY CASE (Y/N): N
-- -- -- -- -- -- R E CI PI E NT S U M MARY-- -- -- --
              Navigation -
       Moving Between Subsystems
Main Menu - returning to the Main Menu screen using the PF3
or PF6 Keys allows you to enter into another subsystem.

PF4 and the PF5 Keys - allows you to leave the subsystem you
are currently viewing to move to a different subsystem without
logging out of one and into another.

Next Field - by typing in the name of the Keypanel Screen of the sub-
system you wish to go to (e.g. RKEY, PKEY) you will leave the
screening document to go directly to that subsystem.
         Navigation -
Programmable Function (PF) Keys
These keys are found at the top of your keyboard and are labeled
“F1 - F12". Each key has a specific purpose in the Prior
Authorization subsystem. The purpose of the keys may be different
in other subsystems.

The PF Key line at the bottom of the screen indicates which key is
available by showing the title of the PF Key underneath if that key
can be used.

ENTER-PF1-PF2-PF3-PF4-PF5-PF6-PF7-PF8-PF9-PF10-PF11-PF12
 PAGE S/EXT        N/EXT                  OOPS
                      Navigation
PF1 Displays/Hides PF Key line at bottom of screen and provides
the title of an edit when cursor is placed on that edit.

PF2    Copies text from one Comment Screen to the next.

PF3    Save & Exit - Saves changes and exits document.

PF4 Leaves the current subsystem to enter into another subsystem
for more information. The PF4 key defaults to the Recipient
Subsystem when the cursor is placed anywhere on the screening
document or service agreement. It can also be used when the cursor
is on the case manager number, diagnosis code(s) or edit(s) of the
screening document. For service agreements, the above is true as
well as using the key when the cursor is on the procedure code.
                          Navigation
PF5 Leaves the current subsystem to enter into the Recipient or
Provider subsystem for more information. Allows navigation to a
recipient or provider not associated with the case you are presently
using.

PF6 Exits out of document without saving changes. There is no
“last minute warning” to save data that was just entered if it wasn’t
saved prior to using this key.

PF7 Scrolls backward for more information on a screen if indicated
by a +/-.

PF8 Scrolls forward for more information on a screen if indicated
by a +.
                            Navigation
PF9 Edits screening document and service agreement. Assures that
there are no errors, invalid values, blank fields, or data in conflict with
other subsystems. Edit(s) will post at the bottom of the screen when
corrections are needed.

PF10 Clears current screen of recent changes. It does not erase any
data that was saved in the past or data that is on other screens. This
key needs to be used prior to using the PF9 key or transmitting to
another screen.

PF11 Provides more blank line items on the service agreement.

PF12 Not available in the Prior Authorization subsystem.
                Mini Test
• How will the cursor move using these
  methods: Home Key, Arrow Keys, Enter
  Key, Tab Key, Shift/Tab Keys

• What methods will allow you to advance to
  the next screen?

• What is the function of each of the PF Keys
  in the Prior Authorization Subsystem?
                       Subsystems
Each part of MMIS is called a “subsystem”. Claims is found in the
claims subsystem, provider enrollment data is found in the provider
subsystem, screening documents and service agreements are found
in the prior authorization subsystem, and so on.

While there are several different subsystems, we will review four in
this training that interacts with the LTC screening documents and
service agreements.
              Recipient Subsystem
The Recipient Subsystem holds information for every person who was
screened through the Long Term Care Consultation process or who
applied for public programs. Much of the information comes from the
MAXIS system that the financial workers use to record program
financial eligibility data.

Some screens in this subsystem will assist you when working with
screening documents and service agreements. We will review just
those screens so you are familiar with the format and what information
can be found on these screens. The RSUM screen will be separated
into each section while the other screens are described in whole.

To enter into the Recipient Subsystem, locate its name on your Main
Menu, use your Enter Key to move to that line, and place an “x” in
front of the line. Use your Transmit Key.
                      Recipient Subsystem
11/22/00 12:55:19 MMIS MAIN MENU - MAIN PROD DY00 PWMW000
         *** MEDICAID MANAGEMENT INFORMATION SYSTEM ***
 SEL                                                      SEL
  CLAIMS PROCESSING APPLICATIONS:               OTHER APPLICATIONS (CONT.):
   INQUIRY                             TPL RESOURCE FILE APPLICATION
  REFERENCE FILE APPLICATIONS:         RECIPIENT MISCELLANEOUS FUNCTION
                                       MANAGED CARE
   PROC, DRUG, DIAG, DRG, UPC
   RATES
   EXCEPTION CONTROL
   TEXT
   SYSTEM PARAMETERS/LIST PARAMETERS
  PRIOR AUTHORIZATION APPLICATIONS:
   PRIOR AUTHORIZATION
   SCREENINGS
  OTHER APPLICATIONS:
   PROVIDER FILE APPLICATION
 X RECIPIENT FILE APPLICATION
   TPL BILLING APPLICATION
   MISCELLANEOUS FUNCTIONS
   SECURITY ADMINISTRATION
   FINANCIAL CONTROL

ENTER--PF1--PF2--PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
The next screen to appear is the Keypanel Screen. This is where you
identify what action you will use (I - inquiry, A - add, C - change or
D - delete). You also identify the recipient by completing one of the
fields in the first section. For this training we will use a fictionist
person named Arlo Anderson.

1)     Place an “I” in the Action Code field.
2)     Move the cursor to the first section (use the Enter Key)
3)     Type “anderson” in the last name field
4)     Type “arlo” in the first name field
5)     When finished, use the Transmit Key
NEXT: 11/22/00 12:57:44 MMIS RECIP KEY PANEL-RKEY PWMW101
ACTION CODE: I (A=ADD/C=CHANGE/I=INQUIRY/R=MCRE
REDET/T - - - - - - - - - - R E C I P I E N T K E Y P A N E L - - - - - - - - - - - - - - - - -
RECIPIENT ID:
                               SSN:               MEDICARE ID:
RECIP LAST NAME: anderson                      FIRST: arlo          INIT:
DOB(MM/DD/YYYY):                 - ALSO ENTER NAME
------------------------------------
  CASE NUMBER:                CLIENT OPTION NBR:           CASE TYPE:

*************************** RECIPIENT SCREENS **************************
* RBEN - BEN LIMITATIONS RBUY - RECIP BUYIN        RCAP - ANNUAL CAPS
* RCIP - RECIPIENT INFO RELG - ELIGIBILITY     REMP - MCRE EMPLR
* RFED - FED RPT CAT RRSL - RSL PROGRAM         RHND - HANDICAP DIAG
* RHSP - MH/HSPC/CONS RIDS - PREVIOUS IDS        RIND - MCRE INDIV
* RLTC - LONG TERM CARE RLVA - LIVING ARRANGE RMCR - MEDICAR
* RMGR - CASE MANAGER RPAR - PARENT INFO            RPCR - RECIP PCUR
* RPOL - RECIP POLICIES RTRK - TRACKING        RENR - ENROLLMENT
***************************** CASE SCREENS *****************************
* RCAD - CASE ADDRESS RCHP - CASE HLTH PLANS RCIN - CASE INFO
* RINC - CASE INCOME    RSLT - CASE RESULTS      RREP - CASE AREP
*************************************************************************
ENTER--PF1-PF2-PF3-PF4--PF5-PF6-PF7-PF8-PF9--PF10--PF11-PF12
                          Recipient
If you chose any field other than the Recipient ID field to identify the
recipient, you will be brought to a Selection Screen to view recipients
closest to your criteria. The +/- symbol on the bottom right hand of the
screen indicates there are more choices than can be viewed on the same
screen. Use your PF7 key to scroll backwards on the list and the
PF8 key to scroll forward to view additional recipients.

Use the Enter Key to move the cursor to the line showing the name
Anderson, Arlo. Place an “X” here and use the Transmit Key.
             Recipient – RSEL Screen
NEXT: 11/22/00 13:03:01 MMIS RECIP SELECTION-RSEL             PWMW112
NAME: anderson   arlo
SSN:          MCARE:             DOB:
----------------RECIPIENT SELECTION SCREEN--
       RECIP S                                                    DOB     S
       ID       T ----- NAME ------ SSN MCARE ID MMDDYYYY X
       01792910 A Anderson, Arlo         470420722 470420734A 04291906    M
    X 01792630 A Anderson, Arlo          000000000             07281964   M
       01077657 A Anderson, Art          224075518 474335518A 11011924    M
       01486420 A Anderson, Artandrea 177223629 477226629A 11171900       F

                                                                          +/-
ENTER-PF1-PF2-PF3-PF4-PF5--PF6--PF7--PF8--PF9--PF10--PF11-PF12


        NOTE: THE FOLLOWING SCREENS ARE EXAMPLES. FOLLOW THE
        MMIS SCREENS ON YOUR COMPUTER TO VIEW THE DATA FOR THE
        PERSON YOU SELECTED. THE INSTRUCTIONS ARE THE SAME.
The first screen to appear is the Summary Screen. It contains the current information
from several of the other detailed screens.

NEXT: RBEN 11/22/00 MMIS RECIP SUMMARY-RSUM 09/30/00 PWMW101792630
04/29/1906                 * RECIPIENT RECIPIENT ON REVIEW (Y/N):
ANDERSON          ARLO * STATUS          TPL POLICY COVERAGE (Y/N): Y
**********************************     A      TPL RECOVERY CASE (Y/N): N
-- -------- ----- -RECIPIENT SUMMARY----- ---
* PROGRAM: M MEDICAID ELIG TY: EX OVER AGE 65/NO SUB-TYPE
   CASE NBR: 00815372         ELIG BEG: 04/01/98 ELIG END: 02/22/00 CFR: 009
 PROGRAM: Q QMB               ELIG TY: EQ OVER 65/QMB ONLY
   CASE NBR: 00815372         ELIG BEG: 11/01/99 ELIG END: 02/22/00 CFR: 009
 PROGRAM: U UNKNOWN ELIG TY: UN UNKNOWN
   CASE NBR: S0180943 ELIG BEG: 04/16/98 ELIG END: 05/31/98 CFR: 009
* SPENDDOWN TYPE:A METHOD:I CVRD POP:M BEG DT:2/01/00 END DT: 02/29/00
 SPENDDOWN TYPE:A METHOD:I CVRD POP:M BEG DT: 1/01/00 END DT: 01/31/00
 SPENDDOWN TYPE:A METHOD:I CVRD POP:M BEG DT: 12/01/99 END DT: 12/31/99
 WAIVER TY:K BEG DT:5/25/99 THROUGH DT:2/22/00 LAST SCREEN DT: 02/22/00
   PPHP/MANAGED HEALTH BEG DT:8/01/98 END DT:2/29/00 PROV NBR:4057139 00
   PPHP/MANAGED HEALTH BEG DT:           END DT:       PROV NBR:
* LA: 41 NFI    BEG DT: 04/18/98 END DT: 99/99/99 O/H PROV NBR: 3152456 00
  LA: 80 COMMUNITY BEG DT: 04/01/98 END DT: 04/18/98 O/H PROV NBR:
   PCUR CASE MGR BEG DT:         END DT:      PROV NBR:
* MCARE PART A BEG: 04/01/71 END: 02/29/00 PART B BEG: 11/01/99 END: 02/29/00
            RSUM Screen - Eligibility
NEXT: RBEN 11/22/00 MMIS RECIP SUMMARY-RSUM 09/30/00 PWMW111
02231040                 04/29/1906        * RECIPIENT RECIPIENT ON REVIEW (Y/N): N
ANDERSON                  ARLO             * STATUS      TPL POLICY COVERAGE (Y/N): Y
**********************************                  A      TPL RECOVERY CASE (Y/N): N
- - - - - - - - - - - - -- - - R E C I P I E N T S U M M A R Y - - - - - - -
* PROGRAM: M MEDICAID ELIG TY: EX OVER AGE 65/NO SUB-TYPE
   CASE NBR: 00815372 ELIG BEG: 04/01/98 ELIG END: 02/22/00 CFR: 009
  PROGRAM: Q QMB                    ELIG TY: EQ OVER 65/QMB ONLY
   CASE NBR: 00815372 ELIG BEG: 11/01/99 ELIG END: 02/22/00 CFR: 009
  PROGRAM: U UNKNOWN ELIG TY: UN UNKNOWN
   CASE NBR: S0180943                ELIG BEG: 04/16/98 ELIG END: 05/31/98   CFR: 009

This first section identifies the major programs that the person was
found to be financially eligible. The three most recent spans are
shown. If there are additional older spans, an “*” would appear and
you would need to view the RELG screen to see the additional
spans.
          RSUM Screen - Spenddown
*SPENDDOWN TYPE:A METHOD:I CVRD POP:M BEG DT:2/01/00 END DT: 2/29/00
SPENDDOWN TYPE:A METHOD:I CVRD POP:M BEG DT: 1/01/00 END DT: 1/31/00
SPENDDOWN TYPE:A METHOD:I CVRD POP: M BEG DT: 12/01/99 END DT12/31/99


The three recent spenddown types and the periods are shown here. If
there are additional older spans, an “*” would be shown. You would need
to view the RSPD screen to view these other spans.
              RSUM Screen - Waiver
WAIVER TY:K BEG DT:05/25/99 THROUGH DT:02/22/00 LAST SCREEN DT:02/22/00


If the person is opened to a waiver program, the current span would be
shown here. An “*” indicates additional eligibility periods that can be
viewed on the RWVR screen.
      RSUM Screen - Managed Care
PPHP/MANAGED HEALTH BEG DT:8/01/98 END DT:02/29/00 PROV NBR:00000000
PPHP/MANAGED HEALTH BEG DT:          END DT:       PROV NBR:


Eligibility in the PMAP or MSHO program is shown here. More spans
are on the RPPH screen.
                   RSUM Screen
               - Living Arrangement
*LA: 41 NFI    BEG DT:04/18/98 END DT: 99/99/99 O/H PROV NBR: 0000000 00
LA: 80 COMMUNITY BEG DT: 04/01/98 END DT: 04/18/98 O/H PROV NBR:


The two most recent living arrangements entered by the financial
worker is shown here. Additional spans are shown on the RLVA
screen.
                RSUM Screen
           - PCUR Case Manager and
               Medicare Program
        PCUR CASE MGR           BEG DT:      END DT:      PROV NBR:


This line is not currently used.


* MCARE PART A BEG: 4/01/71 END: 2/29/00 PART B BEG: 11/01/99 END: 2/29/00

The most recent Medicare span is shown. See the RMCR screen for
additional eligibility spans.
                                         Recipient Screens
The rest of the screens will appear in this order by using the Transmit Key. If you wish to navigate directly to a screen, type the name of the screen
in the NEXT field at the top of the screen and press the Transmit Key.
Recipient File Applications
RKEY - Keypanel                                               RPAR - Parent Information
RSEL - List Selection                                         RCIP - Recipient Miscellanous
RSUM - Summary Screen                                         RHCI - Health Care ID
RBEN - Benefit Limitations                                    RVAR - Variable Recipient
RCAP - Annual Caps                                            RBUY - Buy In Monthly Trans
RSPL - Spenddown Search                                       RFED - Federal Reporting Category
RSPD - Spenddown                                              RFD2 - Federal Reporting Category
RSLG - Spenddown Log                                          RMSQ - Medical Service Questionnaire
RLVA - Living Arrangement
RLTC - Long Term Care and Case Mix
RIMG - Immigration
RELG - Eligibility
RIDS - Previous Recipient and Medicare ID                     Case Number Screens
RCAS - Previous Cases                                         RKEY - Keypanel
RWVR - Waiver/CSG Spans                                       RCAD - Recipients’ Home and Medical Mailing Addresses and Financial
RMCR - Medicare                                               County of Servicing
RSVL - Medicare List                                          RREP - Authorization Representative
RSVC - Medicare Services                                      RCIN - Associated Recipients and Financial Worker ID #
RPCR - PCUR Information                                       RCHP - Selected Managed Care Health Plan
RHSP - Mental Health, Hospice, and Conservator
RSPC - Special Processing, DT&H, Transportation
RTRK - Managed Care Tracking
RPPH - Managed Care Enrollment and Exclusion Spans
REFM - Managed Care Enrollment Data
RPPR - Managed Care Rate
RMGR - Case Manager
RPOL - TPL Information
                       “NEXT” Field
The NEXT field can be found on the top left hand corner of the
screen and normally shows the name of the screen that will appear
after the current screen. By typing in the name of the screen you
wish to see and using the Transmit Key, you will be brought right to
that screen. Type in RELG now and press the Transmit Key.

NEXT: RELG 11/22/00 MMIS RECIP SUMMARY-RSUM 09/30/00 PWMW111
0000000 01/01/1900                * RECIPIENT RECIPIENT ON REVIEW (Y/N): N
Rabbit               Bunny        * STATUS     TPL POLICY COVERAGE (Y/N): Y
**********************************              A      TPL RECOVERY CASE (Y/N): N
- - - - - -- - - - - R E C I P I E N T S U M M A R Y - - - - - - -- - - -
             Recipient - RELG Screen
The RELG Screen shows the major programs that the person is
financially eligible.

How it affects screening documents -
If the person is on a waiver program, the waiver program eligibility begin
and end date must be within the major program MA span or edits will
post on the screening document. If the dates on the major program MA
span are not correct, or there isn’t a major program MA span, contact the
financial worker for assistance. When the person is opened to the AC
program, you will see a span for major program AC. The AC
reassessment screening document will extend the end date on this span.
The AC exit screening document will end the span.

How it affects service agreements -
The AC and waiver service agreement period must be within this major
program span or edits will post.
              Recipient - RELG Screen
A +/- sign at the bottom right side indicates there are more spans to
view. Use the PF8 key to view older spans if this symbol is present.
 NEXT: RIDS 11/22/00 14:53:37 MMIS ELIGIBILITY-RELG 09/30/00 PWMW127
                             *
                             *
**********************************
- -- -- -- ---- - -- -- - - ELIGIBILITY - -- -- -- - -- -
01 PROG: M MEDICAID ELIG TY: EX OVER AGE 65/NO SUBTYPE CASE:0099999
  ELIG BEGIN: 04/01/98 ELIG END: 02/22/00 CFR: 009 STATUS: C REASON: 20
STATUS DATE:2/23/00 DATE ADDED:6/15/98 SPENDDOWN (Y/N):Y APPL DT: 4/24/98

02 PROG: Q QMB      ELIG TY: EQ OVER 65/QMB ONLY            CASE: 00000000
   ELIG BEGIN: 11/01/99 ELIG END: 02/22/00 CFR: 009 STATUS: C REASON: 20
STATUS DATE:2/23/00 DATE ADDED:10/12/99 SPENDDOWN (Y/N):N APPL DT: 4/24/98
                                                                           +/-
ENTER--PF1--PF2--PF3-PF4-PF5-PF6-PF7-PF8-PF9--PF10---PF11--PF12



Type RWVR in the NEXT field and press the Transmit Key.
              Recipient - RWVR Screen
This screen lists a history of the person’s waiver programs (CAC, CADI, TBIW, EW,
MR/RC) and the Consumer Support Grant Program. Periods of eligibility and the last
date the person was screened are shown.

These eligibility periods are developed from the opening or reopening screening
document. When a reassessment screening document is entered, the eligibility span is
increased. When an exit screening document is entered, the end date is shortened.

Placing the cursor on the Waiver Type field and using the PF12 key will show a
listing of all the values.

How it affects screening documents -
These waiver spans (developed by the opening or reopening screening document)
must fall within the major program MA eligibility span or edits will post on the
screening document.

How it affects service agreements -
The waiver service agreement header period must also fall within these eligibility
spans or edits will post on the service agreement.
            Recipient - RWVR Screen

NEXT: RMCR 11/22/00 MMIS RECIP WAIVERS-RWVR 11/21/00 PWMW128
                                      *
                                        *
**********************************
- - - - - - - - - - - - - - - - - - - R E C I PI E NT WAIVE R S - - - - -
WAIVER                       WAIVER            WAIVER       LAST
TYPE                       BEGIN DATE THROUGH DATE SCREENING DATE
K EW DIVRSN                  05/25/99            02/22/00   02/22/00



ENTER-PF1-PF2-PF3--PF4--PF5-PF6--PF7-PF8-PF9-PF10-PF11-PF12




Type RMGR in the NEXT Field and press the Transmit Key.
            Recipient - RMGR Screen
The RMGR Screen shows a history of the case manager(s) assigned to
the recipient. This information is taken from the screening document. By
moving the cursor (using the arrow keys) to the provider number and
using the PF4 Key, you can navigate to the Provider Subsystem to view
the case manager information on the PADD screen. When finished, use
the PF3 or PF6 Key to return to the Recipient Subsystem.

Practice using the PF4 Key by using the arrow key to move the cursor
to one of the provider numbers. Press the PF4 Key. You are now in
the Provider File. Press the Transmit Key to go to the PADD screen
(note: this takes a little time; be patient!). Once there, view the case
manager information. When finished, use the PF3 or PF6 Key to
return to the RMGR screen.
          Recipient - RMGR Screen
NEXT: RPOL 11/22/00 MMIS CASE MANAGER-RMGR 11/02/00 PWMW129
                              *
                                *
**********************************
- -- -- -- -- -- - - CAS E MANAG E R - -- -- -- -- --
TYPE                 BEGIN DATE END DATE           PROVIDER NUMBER
CO COUNTY            08/01/97     99/99/99         0000000 00
CO COUNTY            08/01/94     08/01/97         9999999 00




ENTER-PF1-PF2-PF3-PF4-PF5-PF6-PF7-PF8-PF9-PF10-PF11-PF12


Type RLVA in the NEXT field and press the Transmit Key.
           Recipient - RLVA Screen
The RLVA Screen shows a history of the different living
arrangements as determined by the financial worker. If the recipient
is in an institution, you can find the name of the institution by
moving the cursor to the provider number (using the arrow keys) and
pressing the PF4 Key. After viewing the provider screens, use the
PF3 or PF6 Key to return to the Recipient Subsystem.

Putting the cursor on the Living Arrangement field and using the
PF12 key will show a listing of all the values.

How it affects the service agreements -
If the recipient is on a waiver program, the living arrangement type
must be a community type. The services on the service agreement
must not overlap an institutional span more than the admission or
discharge date or edits will post on the line item(s).
             Recipient - RLVA Screen
NEXT: RLTC 11/22/00 MMIS LIVING ARRANGE-RLVA 09/30/00 PWMW135
                            *
                            *
**********************************
- - - - - - - LTC I N E LI G I B LE I N F O R MATI O N - - - - - -
INELIG TYPE BEGIN DATE END DATE INELIG TYPE BEGIN DATE END DATE


- - - - - - - - L I V I N G A R R A N G E M E N T S - - -- - - - - - - - -
                                          LIVING                           OUT OF HOME
       BEGIN DATE END DATE ARRANGEMENT                       PROV NBR              01
04/18/98                 99/99/99        41 NFI                            9999999 00
02 04/01/98              04/18/98        80 COMMUNITY
03 07/09/96              01/01/97        80 COMMUNITY

ENTER-PF1-PF2-PF3-PF4-PF5-PF6-PF7-PF8-PF9-PF10-PF11-PF12


Type RPPH in the NEXT Field and press the Transmit Key.
                Recipient - RPPH Screen
When a person is enrolled in the Minnesota Senior Health Options (MSHO) Program,
the PrePaid Health Plan (PPHP) Program, or the Minnesota Disability Health Options
(MnDHO) Program, the excluded and/or eligibility periods are shown on the RPPH
Screen.

If the person is in a managed care county where it is mandatory for eligible people to be
enrolled with a health plan, and that person is found to be ineligible, the exclusion
reason and period is located on the first half of the screen.

How it affects the screening documents -
A person on the MSHO Program (identified by Product ID “MA02") or the MnDHO
Program (identified by Product ID “MA15”) cannot be on a waiver or AC program at
the same time and edits will post on the screening document.

How it affects the service agreements -
A person on the PPHP Program (identified by any other product ID number) can be on
the waiver or AC program, but some services will be provided and paid by the health
plan. Edits will appear on the service agreement if the service is provided/paid by the
managed care health plan.
                      Recipient - RPPH Screen
The exclusion reasons for managed care programs are:

            AA = Adoption Assistance
            BB = Blind/Disabled Under 65 Years Old
            CC = Child Protection Case
            DD = Terminal Communicable Disease
            EE = Severe Emotional Disease
            FF = Child in licensed foster care/out-of-home placement
            GG = Geographic Location
            HH = Private HMO Coverage
            JJ = GAMC Special Exclusions
            KK = SIS/EW
            MM = Native American living on a reservation
            QQ = QMB/SLMB Only or QWD major program types
            RR = Federal Refugee Assistance Program
            SS = Medical spenddown
            TT = Terminal Illness
            UU = Limited Disability (Must be DHS approved)
            WW = Nursing Home (Waiting)
            XX = Unknown. Used for MMIS conversion
            YY = Pending enrollment for less than 30 days
            ZZ = RTC/IMD/State Institution Resident
                      Recipient - RPPH Screen
When the person is enrolled in a health plan, many services including home care services are provided by the health
plan rather than by the waiver or AC service agreement. By moving the cursor (using the arrow keys) to the
Contract Number field and using the PF4 Key, you can view the type of health plan they are enrolled with.
Use the PF3 or PF6 Key when finished to return to the RPPH Screen.


NEXT: REFM 11/22/00 MMIS MANAGED HEALTH-RPPH 09/30/00 PWMW137
                          *
                          *
E-X-C-L-U-S-I-O-N---I-N-F-O-R-M-A-T-I-O-N - - - - - - -
XCL TY BEGIN DT END DATE XCL TY BEGIN DT END DATE XCL TY BEGIN DT
YY C0 06/01/98 07/31/98

  - - - - - PPH P/ MANAG E D H EALTH E N R O LLM E N
T - - - - ENROLLMENT--     CONTRACT --PRODUCT - DATE LAST CHG DIS
TRK
BEGIN DT END DATE NUMBER ID DESCRIPTION ADDED CAP PAY                   RSN
01 08/01/98 02/29/00 9999999 00 M 01 PREPAID MEDI C0 07/16/98 02/00 IN DT S

ENTER-PF1-PF2-PF3-PF4-PF5-PF6-PF7-PF8-PF9-PF10-PF11-PF12

Type RSPD in the NEXT Field and press the Transmit Key.
             Recipient - RSPD Screen
This screen holds a history of the spenddown types and amounts. The
type of spenddown can be either A - Automatic, M - Manual or W -
SIS/EW. The Method can be I - Institutional or M - Medical. One
month is shown on each screen. If you see a “+” at the top of the screen,
you can use the PF7 or PF8 Keys to scroll to other months. The recipient
may assign up to five providers to pay the spenddown. They will be
listed at the bottom of the screen. Using your arrow key, you can move
the cursor to the Provider Number and press the PF4 Key to view the
name of the provider(s) who will pay the spenddown. Use the PF3 or
PF6 Key to return to this screen.

Putting the cursor on the Type, Method or Covered Population fields and
using the PF12 key will show you the values for these fields.
             Recipient - RSPD Screen
NEXT: RSLG 11/22/00 15:49:15 MMIS SPENDDOWN-RSPD 03/07/00 PWMW132
                         *    CLIENT OPTION NUMBER:
                         *                                               +
********************************** - - - - - - S P E N D D O W N - - - -
TY: A MTHD: I CVRD POP: M PERIOD BEGIN: 02/01/00 PERIOD END: 02/29/00
SATISFY:        ORIG SPDWN AMT:$ 8               RECIPIENT AMT:$8
USED AMT:$8.00 CLIENT OPT PD:$                   FC/MSHO:$
                                                  REMAINING AMOUNT:$
 PROVIDER AMOUNT USED
3152456 00   8.00          8.00   PROVIDER AMOUNT               USED


 - - - - - - - - - -AS S O C IATE D R E C I PI E NT S - - - - - -
ENTER-PF1-PF2-PF3--PF4--PF5-PF6--PF7-PF8-PF9--PF10-PF11-PF12


Type RMCR in the NEXT Field and press the Transmit Key.
           Recipient - RMCR Screen
The RMCR Screen shows a history of the eligibility periods for
Medicare Part A and Part B. This screen can be updated by the LTC
screening document for Alternative Care recipients. If a span has a
source code of “L”, that information was obtained from a screening
document. Changes to an “L” span cannot be completed directly on
this screen but a phone call to the MMIS User Services Help Desk is
needed to make changes to the span. This phone number is (651)
282-3744.

How it affects service agreements -
An informational edit will appear on the service agreement if the
recipient is also eligible for Medicare. Some services should be billed
through Medicare instead of the waiver or AC programs.
                Recipient - RMCR Screen
NEXT: RPCR 11/27/00 MMIS RECIP MEDICARE-RMCR 09/30/00 PWMW134
                                 *
                                 *   MEDICARE ID: 99999999A
**********************************
- - - - - - - - - - - - M E D I CAR E PAR T A - - - - - - - - - -

MEDICARE PART A BENEFITS EXHAUSTED (Y/N):
BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP (Y/N)
04/01/71    02/29/00 M

 - - - - - - - - - - - - M E D I C A R E P A R T B - - - - - - - - - - - BEGIN DATE END DATE
SRC PPHP (Y/N) BEGIN DATE ENDDATE SRC PPHP (Y/N)
11/01/99                02/29/00 S                04/01/71             02/29/00  M

ENTER-PF1-PF2-PF3-PF4---PF5--PF6--PF7-PF8-PF9-PF10-PF11-PF12


Type RVAR in the NEXT Field and press the Transmit Key.
            Recipient - RVAR Screen
The RVAR screen should be used if extensive research is needed in
the Recipient Subsystem. It shows which screens have data and which
screens are blank. Those screens with a “Y” indicated have information
to view.
                  Recipient - RVAR
NEXT: RBUY 11/27/00 MMIS VARIABLE RECIP-RVAR 09/30/00 PWMW123
                         *
                         *
 ********************************** - - V A R I A B L E R E C I P I E NT--
ANNUAL CAPS (Y/N): Y - RCAP                MEDICARE PART B (Y/N): Y -RMCR
BENEFIT LIMITATIONS (Y/N): Y - RBEN MENTAL HEALTH (Y/N): N - RHSP
BUYINS (Y/N): Y - RBUY                     MINNESOTACARE (Y/N): N - RIND
CASE MANAGERS (Y/N): Y - RMGR             MSQ (Y/N): N - RMSQ
CASE MIX (Y/N): Y - RLTC
PARENT INFORMATION(Y/N): N - RPAR
CONSERVATORS (Y/N): N - RHSP               PCUR (Y/N): N -RPCR
DTH (Y/N): N - RSPC              PPHP ENROLLMENTS (Y/N):Y RPPH
ELIGIBILITY SPANS (Y/N): Y - RELG          PPHP EXCLUSIONS (Y/N): Y - RPPH
FED RPT CATEGORY (Y/N): Y - RFED           PREV MEDICARE IDS (Y/N):N -RIDS
HANDICAP DIAGNOSIS (Y/N): N - RHND PREV RECIPIENT IDS (Y/N): N RIDS
RSL PROGRAM (Y/N): N - RRSL                SCH FAMILY INCOME (Y/N):N RSCH
HOSPICE (Y/N): N - RHSP                    SPECIAL PROCESSING (Y/N): NRSPC
LIVING ARRANGEMENTS (Y/N):Y RLVA SPENDDOWNS (Y/N): Y - RSPD LONG
TERM CARE (Y/N): N - RLTC        TPL RESOURCES (Y/N): Y - RPOL LTC
INELIGIBLE (Y/N): N - RLVA       SPECIAL TRANSPORTATION: RSPC
MEDICARE PART A (Y/N): Y - RMCR          WAIVERS (Y/N): N - RWVR
              Recipient - RVAR
Type RSUM in the NEXT Field and press the Transmit Key.
              Recipient - Case File
In order to view a recipient’s current mailing address, previous
mailing address and an alternative medical mailing address (if any)
the person’s case number is needed. A case number is different
from a PMI number. It is a number that is shared by all persons
within a household -- it is what links individual PMI's together as
being somehow related. The case number can be found on either
the RSUM screen or the RELG screen.

Write down the client's case number, then use the PF3 or PF6
Key to return to the Keypanel Screen.
                 Recipient - Case File
NEXT: RBEN 03/12/98 08:10:02 MMIS RECIP SUMMARY-RSUM 10/25/00 PWMW11
                         * RECIPIENT RECIPIENT ON REVIEW (Y/N): N
                         * STATUS       TPL POLICY COVERAGE (Y/N): N
**********************************    A      TPL RECOVERY CASE (Y/N):
------------ -------RECIPIENT SUMMARY----------------
* PROGRAM: M MEDICAID ELIG TY: AP AFDC RELATED/INCAPACITATED
  CASE NBR: 0000000 ELIG BEG: 05/01/97 ELIG END: 10/31/97 CFR: 002
 PROGRAM: M MEDICAID ELIG TY: AP AFDC RELATED/INCAPACITATED PAR
  CASE NBR: 9999999 ELIG BEG: 08/01/95 ELIG END: 12/31/95 CFR: 002
 PROGRAM: X MCRE        ELIG TY: M2 MINNESOTACARE GROUP II
  CASE NBR: X099999 ELIG BEG: 09/01/95 ELIG END: 09/30/95 CFR: MCR

Once on the Keypanel Screen, delete the PMI number or person’s name in the
top section of the RKEYscreen. Move your cursor to the CASE NUMBER field
in the second section and enter the case number you wrote down. Press the
transmit key. You should now be on the RCAD screen.
                 Recipient - Case File
NEXT: 11/22/00 12:57:44 MMIS RECIP KEY PANEL-RKEY PWMW101
ACTION CODE: I (A=ADD/C=CHANGE/I=INQUIRY/R=MCRE REDET/T
- - - - - - - R E C I P I E N T K E Y PAN E L - - - - - - - - - - - - - -
RECIPIENT ID:
SSN:                                 MEDICARE ID:
RECIP LAST NAME:                     FIRST:        INIT:
DOB(MM/DD/YYYY):               - ALSO ENTER NAME
-----------------------------------
CASE NUMBER:              CLIENT OPTION NBR:         CASE TYPE:

*************************** RECIPIENT SCREENS *************************
* RBEN - BEN LIMITATIONS RBUY - RECIP BUYIN RCAP - ANNUAL CAPS
* RCIP - RECIPIENT INFO RELG - ELIGIBILITY      REMP - MCRE EMPLR
* RFED - FED RPT CAT RRSL - RSL PROGRAM RHND - HANDICAP DIAG
* RHSP - MH/HSPC/CONS RIDS - PREVIOUS IDS        RIND - MCRE INDIV
***************************** CASE SCREENS ****************************
* RCAD - CASE ADDRESS RCHP - CASE HLTH PLANS RCIN - CASE INFO
* RINC - CASE INCOME RSLT - CASE RESULTS         RREP - CASE AREP
*************************************************************************
ENTER--PF1-PF2-PF3-PF4--PF5-PF6-PF7-PF8-PF9--PF10--PF11-PF12
              Recipient - Case File
NEXT: RCIN 03/12/98 MMIS CASE ADDRESS-RCAD 06/02/00 PWMW115
CASE NUMBER: 00651906 *    REFERRAL SOURCE:
CASE TYPE: D CNTY ADM * ENROLL LANGUAGE CODE: LANGUAGE CODE

-----------------RESIDENTIAL ADDRESS-------------- -
    ADDR: 39 Main Street        PREV ADDR: 400 Main Street
    ADDR:                               PREV ADDR:
    CITY Hometown                   PREV CITY: Anytown
    STATE: MN    ZIP: 55555             PREV STATE: MN ZIP: 55555
   COUNTY: 002      PHONE: 555 555-1212 PREV COUNTY:
 EFFECTIVE DT: 060297

------------- ---MEDICAL MAILING ADDRESS---------
  LAST NAME:         FIRST NAME: INIT:
  ADDR:
  ADDR:
   CITY:          STATE:   ZIP:
               Mini Test
• What is the purpose of the Keypanel
  Screen?
• What is the purpose of the Selection
  Screen?
• Explain what information can be found on
  each screen we’ve reviewed.
• Where can you find the recipient’s case
  number?
• What information will you find on the
  RCAD screen?
             Provider Subsystem
The Provider Subsystem holds information for every provider
enrolled with the Department through the Provider Enrollment
Unit. We will review four detail screens in this subsystem.

If any data in this subsystem needs to be changed, added or
deleted, the waiver or AC provider should call the DHS Provider
Enrollment Unit at (651) 296-2160.

To enter into the Provider Subsystem, locate its name on your
Main Menu, use your Enter Key to move to that line, and place
an “x” in front of the line. Use your Transmit Key.
                         Provider Subsystem
11/22/00 12:55:19 MMIS MAIN MENU - MAIN PROD DY00 PWMW000
         *** MEDICAID MANAGEMENT INFORMATION SYSTEM ***
 SEL                                                      SEL
  CLAIMS PROCESSING APPLICATIONS:               OTHER APPLICATIONS (CONT.):
   INQUIRY                             TPL RESOURCE FILE APPLICATION
  REFERENCE FILE APPLICATIONS:         RECIPIENT MISCELLANEOUS FUNCTION
                                       MANAGED CARE
   PROC, DRUG, DIAG, DRG, UPC
   RATES
   EXCEPTION CONTROL
   TEXT
   SYSTEM PARAMETERS/LIST PARAMETERS
  PRIOR AUTHORIZATION APPLICATIONS:
   PRIOR AUTHORIZATION
   SCREENINGS
  OTHER APPLICATIONS:
X PROVIDER FILE APPLICATION
   RECIPIENT FILE APPLICATION
   TPL BILLING APPLICATION
   MISCELLANEOUS FUNCTIONS
   SECURITY ADMINISTRATION
   FINANCIAL CONTROL

ENTER--PF1--PF2--PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
                 Provider Subsystem
The first screen you will see is the Keypanel Screen where you
identify which provider record you wish to view, add, change or delete.
Using the Provider Number field will bring you directly to the file.
Otherwise, any one of the other fields in the first section will bring you
to the Selection Screen. To view information about a Managed Care
health plan provider contract, use the health plan provider number in the
second section.

Use an Action Code of “I”. Press the Tab and Enter Keys to move
the cursor to the Provider Name field. Type in (choose your own
provider name). Use the Transmit Key.
                       Provider Subsystem
NEXT: 11/27/00 9:45:28           MMIS PROV KEY PANEL -PKEY                            PWMW200
ACTION CODE: I           (A=ADD/C=CHANGE/D=DELETE/I=INQUIRY)
 ------------ PROVIDER MASTER FILE - - - - - - - - - - - - - - - - - - - - - - - - -PROV NBR:
UPIN:                               PROV LICENSE:
PROV SSN:             PROV FEIN:                             MINN TAX ID:
                      PROV COS/COUNTY:         PROVIDER COS:
                      MCARE NBR/CARRIER ID:                 OLD PROV NBR:
                      PROVIDER NAME: Hospital Home Supplies
 ---------------- PPHP/MCP CONTRACT FILE - - - - - - - - - - - - - - - - - - -
             PROVIDER NUMBER:                  EFF DATE:
 ***************************************************************************
PARH - ACCTS RECV HIST PPCS - PROV CLAIMS SUMM PPSP - PREV CLAIM
SUMM PADD - PROVIDER SCREEN 1 PBIL - BILLING AGT PROVS PCOS -
PROV CAT OF SVC PFIN - PROV FIN. DATA PGRP - GRPS/BILLING AGTS
PHSP - PROV HOSP DATA PINF - PROV INFORMATION PLAB - LABS CLS
PLIC - PROV LICENSES PMBR - INDIV IN GROUP PPGM - PROV ADDRESS/PGMS
PPHC - RATE CELLS PPH1-CONTRACT SCREEN 1 PPH2-CONTRACT COS CVRG
PPH3-CONTRACT PRV CVRG PPX1 - PPHP AFFIL 1

ENTER--PF1--PF2-PF3-PF4--PF5-PF6-PF7-PF8-PF9-PF10-PF11-PF12
             Provider - PINQ Screen
Since you did not use the Provider Number field, you will be shown
this Selection Screen to select the provider record you need. Use the
PF7 or PF8 keys to scroll back and forth on this screen to view
different providers.

Place an “X” in front of the provider you wish to view. Press the
Transmit Key.
                Provider - PINQ Screen
NEXT: 11/27/00 9:55:56 MMIS PROVIDER LIST -PINQ                   PWMW201
SELECTION CRITERIA: HOSPITAL

 NAME AND ADDRESS                    NUMBER LICENSE SSN/FEIN
X HOSPITAL                           9999999 00    9999 XX-9999999
                                       SPEC: SELF RESTRICT: PROV TYPE: 70
            Street Address           PHONE:               COUNTY: 044
                 City, State, Zipcode STATUS: G TERM N/CLM EFF DATE: 05/03/97

 HOSPITAL SUPPLIES               88888888 00          XX-8888888
                                  SPEC: SELF RESTRICT: 0 PROV TYPE: 76
       Street Address           PHONE:                  COUNTY: 093
       City, State, Zipcode   STATUS: G TERM N/CLM EFF DATE: 03/31/90

 HOSPITAL ASSOCIATES 7777777 00                 XX-77777777
                                SPEC: SELF RESTRICT: 0 PROV TYPE: 20
      Street Address           PHONE:                   COUNTY: 002
      City, State, Zipcode     STATUS: 1 ACTIVE         EFF DATE: 09/01/74
                                                                        +/-
ENTER-PF1-PF2-PF3-PF4-PF5-PF6-PF7-PF8-PF9-PF10-PF11-PF12
               Provider - PSUM Screen
The first detailed screen to view is the PSUM Screen. It gives current information
from some of the other screens in the subsystem.

The Provider Type is important as each waiver and AC service is limited to specific
types of providers. If this provider was added to a service agreement for a service
that didn’t include their provider type number, an edit would post indicating that a
different provider was needed. (A listing of the provider types is at the end of this
section).

The Major Programs section is important. If major program AC was not shown,
this provider could not be used with Alternative Care recipients. If major program
MA was not shown, this provider could not be used with waiver recipients.

The Category of Services lists those services that the provider may do. (A listing of
the Service Codes is at the end of this section).
                      Provider - PSUM
NEXT: PADD 11/27/00 MMIS PROVIDER SUMM PSUM 05/06/97 PWMW216
PROV NBR: 8320209 00         PROV TY: 70 PHARMACY FEIN: xx-99999999 SSN:
NAME: HOSPITAL              MN TAX ID:             UPIN:     + STAT: G 05/03/97
RESTRICT/SANC IND: SELF RESTRICT: MCAID/MCARE PART
  PCUR DATA - IND BEGIN DT:                END DT:       PROV MANUAL:
  LAST WRNT - NBR: 00000000 DT: 04/15/96 AMT:               36.95 LTA:
---------------- SPECIALTIES ---------------------
CD CERT DT CD CERT DT CD CERT DT CD CERT DT CD CERT DT CD

----MAJOR PROGRAMS --- + BEG DT: 12/01/99 END DT: 99/99/99
    AC BB CC DD EE FF GM HH IM JJ KK LL MA NM QM RM
----- CATEGORIES OF SERVICE/ENHANCED SERVICES -------
BEG/END COS CD COS CD COS CD COS CD COS CD COS CD COS CD COS CD
         10/01/93 030  032      076     116    120
99/99/99
-- PACKAGED SERVICES DATA - - - - - - HOLD/REVIEW DATA --------
     TYPE BEGIN DT END DT          BEGIN DT END DT TYPE HIGH LOW

ENTER-PF1-PF2-PF3-PF4-PF5-PF6-PF7-PF8-PF9-PF10-PF11--PF12
Press the Transmit Key to navigate to the PADD Screen.
            Provider - PADD Screen
Following the PSUM Screen is the PADD Screen. The provider
type number is shown at the top of the screen. A listing of these
numbers follows this screen. A provider’s mailing address and
county of residence is shown here. This address is used to mail the
service agreement letters. If a provider is not receiving their letters,
check this address for accuracy. The phone number is also listed.

The Enrollment information is important. Line items on a service
agreement that do not fall within a period of an Active status will post
an edit. The line item would need to be adjusted to fall within the
active status period or a different provider must be used.
               Provider - PADD Screen
NEXT: PINF 11/27/00 MMIS PROVIDER MASTER-PADD 05/06/97 PWMW202
PROV NBR: 9999999 00 PROV TY: 70 PHARMACY FEIN: XX-9999999 SSN:
NAME: HOSPITAL              MN TAX ID:           UPIN:
PRAC ADDRESS:                                    CORR DATE RECD: 10/18/93
(1) Street Address                               FISCAL YEAR END(MM/DD): 12/31
CITY:                ST:    ZIP:                 TEL: 555 555-1212
CNTY: 093            BRDR(Y/N): Y TYPE PRAC: N/A            FAX:
APP DT: 02/16/94 PROV MANUAL IND:                 SELF RESTRICT IND: OPN DR 20+
MEDICAID PART IND (Y/N): Y MEDICARE PART IND (Y/N): N OWN: X OTHER
MEDICAID AGMT:             BILL AGMT (Y/N): AFFIRM ACT IND: 2 < 50 REIMB
SORT NAME: HOSPITAL                                      DRIVERS LICENSE:
INST OWNER:                                DEA NUMBER:
NEW PROV:                MOST RECENT PREV PROV:
 ---------------- ENROLLMENT ------------------- STATUS           EFF DATE STATUS
EFF DATE STATUS EFF DATE G TERM N/CLM                             05/03/97 1 ACTIVE
10/01/93

ENTER-PF1-PF2-PF3-PF4-PF5-PF6-PF7-PF8-PF9-PF10-PF11--PF12


Type PCOS in the NEXT Field and use the Transmit Key.
Provider
Types      Description
00         NURSING FACILITY
01         HOSPITAL
02         HOSPICE
03         INSTITUTION FOR MENTAL DISEASE
04         RENAL DIALYSIS FREE STANDING
05         ICF/MR - FACILITY
06         CHILDRENS RESIDENTIAL SERVICES
09         SCHOOL DISTRICT
10         COMMUNITY MENTAL HEALTH CENTER
11         REHABILITATION AGENCY
12         SERV FOR CHILDREN W/HAND CLIN
13         SERV FOR CHILDREN W/HAND PROV
14         SOCIAL WORKER-LICENSED IND
16         CHILD AND TEEN CHECKUP CLINIC
17         REGIONAL TREATMENT CENTER
18         HOME AND COMMUNITY SRV PROV.
19         DAY TRAINING & HABILITATN CTR
20         PHYSICIAN
22         AMBULATORY SURGERY CENTER
23         CASE MANAGER(WAIVER)
24         PRE-PAID HEALTH PLAN PROVIDER
25         MARRIAGE AND FAMILY THERAPIST
29         OCCUPATIONAL THERAPY
30         DENTIST
35         OPTOMETRIST
36         PODIATRIST
37         CHIROPRACTOR
38         PERSONAL CARE PROVIDER
39         REGISTERED PHYSICAL THERAPIST
40         SPEECH PATHOLOGIST
41         LIC PSYCHIATRIC PRACTIONER
42         PSYCHOLOGIST
43   AUDIOLOGIST
44   COUNTY APPROVED CASE MNGR
45   COUNTY RESERVATIONS SRVC
46   APPROVED DAY TREATMENT CENTER
47   CNTY CNTRCT MNTL HLTH REHAB SV
48   REGIONAL SERVICES SPECIALIST
51   INDIAN HEALTH FACILITY PROV
52   FEDERALLY QUALIFIED HLTH CTR
53   RURAL HEALTH CLINIC
54   FAMILY PLANNING AGENCY
56   DENTAL LAB
57   PUBLIC HEALTH CLINIC
58   COMMUNITY HEALTH CLINIC
60   HOME HEALTH AGENCY
61   PUBLIC HEALTH NURSING ORG
62   CHEMICAL DEPEND FREE STANDING
64   PRIVATE DUTY NURSE
65   NURSE PRACTITIONER
66   NURSE MIDWIFE
67   CERT REGISTERED NURSE ANESTH
68   CLINICAL NURSE MENTAL HEALTH
69   PHYSICIAN ASSISTANT
70   PHARMACY
75   OPTICIAN
76   MEDICAL SUPPLIER
77   HEARING AID DISPENSER
78   OTHER NON-PHYSICIAN
79   OTHER NON-TRADITIONAL
80   LABORATORY, INDEPENDENT
81   X-RAY/DIAGNOSTIC
82   MEDICAL TRANSPORTATION PROV
83   LIEN HOLDER
84   STATE DEPARTMENT OF HEALTH
85   STATE DEPT OF HUMAN SERVICES
86   HEALTH CARE FINANCING ADMIN
87   CO-PAY PROVIDER
88   MCRE/MA ACCESS SERVICES
89   SPECIAL CONTRACT PROVIDER
90   INDIVIDUAL
91   EMPLOYER
92   GROUP PAYER
93   MANUFACTURER PHARM/MED SUPPLY
94   MEDICAL REVIEW AGENT
96   LICENSING AGENCY
97   INSURANCE COMPANY
98   BILLING INTERMEDIARY
                  Provider - PCOS
The PCOS Screen lists all the services that the provider may do.
If the service on the service agreement is not identified on this
screen, the provider may not provide that service.

Services may be added or deleted at different times. Note the begin
date when there is more than one line of services on this screen.

A listing of these codes follows this screen.
            Provider - PCOS Screen
NEXT: PLIC 11/27/00 MMIS PROVIDER COS - PCOS 05/06/97 PWMW205
PROV NBR: 9999999 00 PROV NAME: HOSPITAL

----- CATEGORIES OF SERVICE/ENHANCED SERVICES ---------
BEGIN DT END DT CLONE
10/01/93   99/99/99 030 032 076 116 120




ENTER-PF1-PF2-PF3-PF4-PF5-PF6-PF7-PF8-PF9-PF10-PF11-PF12
Service
Codes Service Description
001 INPATIENT HOSPITAL GENERAL
003 INPATIENT HOSP PSYCHIATRY
005 CHILD WLFR TARGETED CASE MGMNT
006 INPATIENT HOSP REHABILITATION
007 OUTPATIENT HOSPITAL SERVICES
011 NURSING FACILITY LEVEL I
013 ICF-MR
014 INPATIENT HOSPITAL IMD
015 INPATIENT LONG TERM HOSPITAL
017 NURSING FACILITY LEVEL II
019 DAY TRAINING AND HABILITATION
020 HOME HEALTH SERVICES
021 CONSUMER DIRECTED CARE
022 TRANSITIONAL SERVICES
028 RTC - DEV DISABILITIES
029 RTC - MENTAL HEALTH
030 PHARMACY SERVICES
032 MEDICAL SUPPLY/DME
033 MODIFICATIONS AND ADAPTATIONS
034 FAMILY COUNSELING & TRAINING
035 BEHAVIORAL PROGRAM SERVICES
036 TRANSPORT, SPECIAL
037 TRANSPORT, AMBULANCE
038 PERSONAL CARE SERVICES
039 CHILD & TEEN CHECKUP OUTREACH
040 CHILD AND TEEN CHECKUP
041 ANESTHESIA
042 PRIM CARE UTILIZATION REVIEW
043   PHYSICIAN SERVICES
044   CASE MANAGEMENT OTHER
045   DENTAL
046   MENTAL HEALTH
050   COGNITIVE THERAPY
051   PHYSICAL THERAPY
052   IEP
053   SPEECH THERAPY
054   OCCUPATIONAL THERAPY
055   PODIATRY
056   AMBULATORY SURGERY
057   CHIROPRACTIC
058   AUDIOLOGY
062   CONSOLIDATED TREATMENT FUND
063   CTF EXTND CARE/HALFWAY HOUSE
071   CASE MANAGEMENT MENTAL HEALTH
072   HOSPICE
073   INPATIENT HOSP NEO-NATAL ICU
074   INPT HOSP 45 DAY PSYCH CONTRAC
075   EYEGLASSES/CONTACT LENSES
076   PROSTHETICS AND ORTHOTICS
077   HEARING AIDS
078   VISION
079   RADIOLOGY, TECHNICAL COMPONENT
080   LABORATORY
082   FED QUALIFIED HEALTH CNTR SVC
083   RURAL HEALTH CLINIC SERVICES
084   SWING BED SERVICES
086   OUTPATIENT HOSP EMERGENCY SVC
087   END-STAGE RENAL DIALYSIS
088   PUBLIC HEALTH NURSING
089   PRIVATE DUTY NURSING
090   NURSE MIDWIFE SERVICES
091   NURSE PRACTITIONER SERVICES
092   NUTRITION SERVICES
093   CHORE
094   COMPANION SERVICES
095   HOME DELIVERED MEALS
096   HOMEMAKER SERVICES
097   CARE GIVER TRAINING
100   ACCESS SERVICES
101   ACCESS TO APPEAL
102   ADULT DAY CARE
103   FOSTER CARE
104   SUPPORTED EMPLOYMENT SERVICES
105   SUPPORTED LIVING SERVICES
106   STRUCTURED DAY PROGRAM SVC
107   RESPITE CARE
108   ASSISTED LIVING SERVICES
109   INDEPENDENT LIVING SKILLS
110   IN-HOME FAMILY SUPPORT
111   DEV DISABILITIES SCREENING
112   PASARR - DD
113   PASARR - MENTAL HEALTH
114   EXTENDED HOME HEALTH AIDE
115   LTC CONSULTATION-PAS
116   EXTENDED MEDICAL SUPPLIES/DME
117   EXTENDED MENTAL HEALTH
118   EXTENDED OCCUPATIONAL THERAPY
119   EXTENDED PERSONAL CARE
120   EXTENDED PHARMACY
121   EXTENDED PHYSICAL THERAPY
122   EXTENDED PRIVATE DUTY NURSING
124   EXTENDED RESPIRATORY THERAPY
125   EXTENDED SPEECH THERAPY
126   EXTENDED TRANSPORTATION
127   PPHP - DPA
128   PPHP - GA
129   PPHP - MANDATORY
130   PPHP - SOCIAL HMO
131   PPHP - SUPPLEMENTAL HMO
132   PPHP - VOLUNTARY AFDC
133   PPHP - MSHO
134   COST EFFECTIVE HEALTH INS
135   CO PAY - MEDICAL SUPPLY/DME
136   CO PAY - MENTAL HEALTH
137   CO PAY - PHARMACY
138   CO PAY - PHYSICIAN
139   COLLECTIONS, MISCELLANEOUS
140   FINANCIAL TRANSACTION
141   SPENDDOWN COLLECTIONS
142   BUY-IN PART A
143   BUY-IN PART B
144   PREMIUM PAYMENTS/COLLECTIONS
999   UNABLE TO DEFINE
                         PFIN Screen
The Alternative Care Program allocates a maximum amount of money per county
to pay for AC services. The PFIN screen identifies the county’s annual allocation
and how much money has been paid out of that allocation. It is updated twice a
month after each claim cycle. This maximum cap amount changes each July 1, or
when the county requests targeted funds to increase the amount during the year.
You will need to leave this training region and log into the production region
in order to view this data (you may do this after you are finished with this
session).
The provider number to use to view the county’s AC allocation amount is
provider type 45 - social services. Do not use provider type 61 - public health
nursing. The provider number is placed in the Provider Number field on the
Keypanel Screen. Type “PFIN” in the NEXT field and press the Transmit
Key. The information is located on the bottom left hand of the screen. There is a
line for the current AC year and the previous AC year. Compare the AC Cap field
with the AC Cap Used field. When both fields match, future AC claims submitted
for this county of financial responsibility will be rejected during the current year.
For more information on AC allocations and the role of the PFIN screen, please
see Bulletin #99-25-16 dated November 10, 1999.
               Mini Test
• What information is found on the PSUM
  screen and how does it affect service
  agreements?
• What information is found on the PADD
  screen and how does it affect services
  agreements?
• What information is found on the PCOS
  Screen and how does it affect service
  agreements?
             Reference Subsystem
The Reference Subsystem identifies the data that restricts how each
service can be used or billed. Waiver and AC services (such as
homemaker, case management, nursing, etc.) are identified in
MMIS by a number starting with “x _ _ _ _”. (Note: new national
codes effective in 2004 will replace many of these “x” codes. These
codes will begin with either a “S” or “T”). This is called a
“procedure code” or “HCPC”. Information for each procedure code
can be found in the PROC, DRUG, DIAG, DRG, UPC file.

To enter into the Reference Subsystem to view additional
restrictions on each waiver or Alternative Care service, locate
the PROC, DRUG, DIAG, DRG, UPC file on your Main Menu.
Use your Enter Key to move to that line, and place an “x” in
front of the line. Use your Transmit Key.
                     Reference Subsystem
11/22/00 12:55:19         MMIS MAIN MENU - MAIN PROD DY00 PWMW000
         *** MEDICAID MANAGEMENT INFORMATION SYSTEM ***
 SEL                                          SEL
   CLAIMS PROCESSING APPLICATIONS:    OTHER APPLICATIONS (CONT.):
   INQUIRY                           TPL RESOURCE FILE APPLICATION
   REFERENCE FILE APPLICATIONS:      RECIPIENT MISCELLANEOUS FUNCTIONS
                                     MANAGED CARE
 X PROC, DRUG, DIAG, DRG, UPC
   RATES
   EXCEPTION CONTROL
   TEXT
   SYSTEM PARAMETERS/LIST PARAMETERS
  PRIOR AUTHORIZATION APPLICATIONS:
   PRIOR AUTHORIZATION
   SCREENINGS
  OTHER APPLICATIONS:
   PROVIDER FILE APPLICATION
   RECIPIENT FILE APPLICATION
   TPL BILLING APPLICATION
   MISCELLANEOUS FUNCTIONS
   SECURITY ADMINISTRATION
   FINANCIAL CONTROL

ENTER-PF1---PF2-- -PF3-- -PF4-- -PF5-- -PF6-- -PF7-- -PF8-- -PF9-- -PF10-- -PF11-- - PF12
         Reference - Keypanel Screen
The Keypanel Screen is used to identify the procedure code you wish to
view.

Use the Action Code of “I”. The Type of Procedure Code will
be “1". Type the Procedure Code number (x5292) in the Procedure
Code field. Use the Transmit Key. (Procedure code x5292 is the
Assisted Living Service).
          Reference - Keypanel Screen
NEXT: 11/27/00  MMIS PDDD KEY PANEL -FKEY        PWMW300
ENTER THE ACTION CODE: I  ACTION CODES: A = ADD D = DELETE
                                        C = CHANGE I = INQUIRY

ENTER ONE OF THE FOLLOWING SELECTION CRITERIA:
PROCEDURES= TYPE OF PROCEDURE CODE: 1 PROCEDURE CODE: X5292
      UPC=              UPC CODE:
      DRUGS=            DRUG CODE:
      DIAGNOSIS=        DIAGNOSIS CODE:
      DRG=              DRG:       COS:          ELIG GRP:
************************************************************************
FPR1 -PROCEDURE CODE(1)         FPR2 -PROCEDURE CODE(2)
FPR3 -PROCEDURE CODE(3)         FPR4 - PROCEDURE CODE(4)
FPR5 - PROCEDURE CODE(5)        FPR6-PROCEDURE CODE(6)
FPR7 - PROCEDURE CODE(7)        FDR1 - DRUG SCREEN(1)
FDR2 - DRUG SCREEN(2)           FDR3 - DRUG SCREEN(3)
FDR4 - DRUG SCREEN(4)           FDR5 - DRUG SCREEN(5)
FDI1 - DIAGNOSIS SCREEN         FDRG - DRG RATE FACTOR
***************************************************************************
ENTER-PF1-PF2--PF3-PF4--PF5--PF6-PF7--PF8-PF9--PF10-PF11-PF12
            Reference - FPR1 Screen
The FPR1 Screen identifies those procedure modifiers that are
acceptable or excluded for use with this procedure code. Next, it
shows those provider types that are acceptable or not acceptable to
provide this service. For x5292, the IND is a “I”, meaning that these
provider types are acceptable to provide this service. An edit will
post on the service agreement if an “excluded” provider type, or a
provider type that is not on the “included” list was used. A different
provider type would then need to be added to the service agreement
(see the Provider Type list from the previous chapter to identify these
numbers).

The LA IND shows the types of living arrangements which are
either included (I) or excluded (E); meaning that these types can or
cannot overlap with the service agreement line item period. An edit
will post on the service agreement to adjust the line item so it doesn’t
overlap with the excluded living arrangement type.
             Reference - FPR1 Screen
NEXT: FPR2 11/27/00 MMIS PROCEDURE CODE1-FPR1 11/12/00 PWMW330
TYPE PROC: 1 PROC CODE: X5292 NAME: ASSISTEDLIVING SERVICES MONTHLY
LONG NAME: ASSISTED LIVING SERVICES MONTHLY

PROC MOD= IND: VALU:
PL OF SVC= IND: VALU:
PROV TYPE= IND: I VALU: 00 01 05 11 18 20 45 51 57 60 61 69

PROV SPEC= IND: VALU:
CLAIM TYPE= IND: I VALU: A
TOOTH NBR= IND: VALU:

 LA IND= IND: E VALU: 41 42 43 46 47 48
 FORMER                 FORMER

PROC CODE BEGIN DT END DATE GRPR PROC CODE BEGIN DT END DATE GRPR

Use your Transmit Key to view the FPR2 screen.
          Reference - FPR2 Screen
The FPR2 Screen identifies the MIN AGE and MAX AGE
(minimum and maximum ages) that can use this service. An edit
will post on the service agreement if the recipient’s age does not
fall within this range.

The DIAG REQD IND(Y/N) indicates if a diagnosis code is
required on the claim form for this procedure code.
              Reference - FPR2 Screen
NEXT: FPR3 11/27/00 MMIS PROCEDURE CODE2-FPR2 11/12/00 PWMW331
TYPE PROC: 1 PROC CODE: X5292 DESC: ASSISTED LIVING SERVICES MONTHLY

CVRD IND(S/D):          MIN AGE: 018     MAX AGE: 999 VALID SEX: B
ABORTION(Y/N):N HCPCS UPD(Y/N):N CERT IND(Y/N):N FAM PLNG(Y/N): N
STERIL(H/O/V):         CTC(Y/N):   COST AVOID(B/P):  HYSTER(Y/N): N
POST OP DAYS: 000       DRG GRPR: 00 FROM THRU(Y/N/R): R INJURY(Y/N): N
REF IND(Y/N):N HX/RETAIN(1-9): N MOD REQD IND(Y/N): N HCFA MAND(Y/N): N
PROFESSIONAL MULTIPLIER DATA DIAG REQD IND(Y/N):N DUPL CHK(Y/N):N
  10/01/90 0.40
-TECHNICAL MULTIPLIER DATA-- TOOTH NBR REQD(Y/N): N MULTI SURG(Y/N):
  10/01/90 0.60
TOOTH SRF REQD(Y/N): N SYS PARAM(Y/N):
RATE FILE RECORD WC PMP PN MP COS PT PS CC RG MN ASC RTC
                (Y/N): Y N N N N N N N N N N                NOTES(Y/N): Y

ENTER-PF1--PF2--PF3-PF4--PF5--PF6-PF7--PF8--PF9--PF10-PF11-PF12


Use your Transmit Key to view the FPR3 screen.
           Reference - FPR3 Screen
The FPR3 Screen identifies the WVR (waiver/AC) types that
provide funding for this service. If a waiver/AC program type is
added or deleted, a new span is shown on the screen. An edit will
post on the service agreement if the type (as shown on the first
screen of the service agreement) does not match one of the types
identified on this screen.

Waiver/AC types are: F/G = CADI, H/I = CAC, J/K = EW, L/M =
TBI-NF, N/O = AC, P/Q = TBI-NB; R/S = MR/RC programs.

This screen also shows the major programs (MAJ PGM/PA-SA)
that the person must be eligible in order to use this procedure code.
              Reference - FPR3 Screen
NEXT: FPR4 11/27/00 MMIS PROCEDURE CODE3 -FPR3 11/12/00 PWMW332
TYPE PROC:1 PROC CODE:X5292 DESC: ASSISTED LIVING SERVICES MONTHLY

BEGIN DT END DATE      PROGRAM CVRG/AUTHORIZATION REQUIREMENTS
02/01/00  99/99/99     WVR: F G J K L M N O P Q
   MAJ PGM/PA-SA:      AC M C N C R C


07/01/97  1/31/00      WVR: F G J K N O P Q
    MAJ PGM/PA-SA:     AC M C RC


06/01/94  06/30/97     WVR: F G J K N O
    MAJ PGM/PA-SA:     AC MC RC


ENTER--PF1-PF2-PF3-PF4-PF5-PF6-PF7-PF8-PF9-PF10-PF11-PF12
                Mini Test
• What information on the FPR1 screen
  restricts how the service can be used?

• What information on the FPR1 Screen
  restricts who may use the service?

• What information on the FRP3 Screen
  restricts how the service may be funded?
                  Claims Subsystem
In order to complete this portion of the training, you must leave this
training region and continue in the production region (the real
world). Claims are not in this training region. See the last slide for
instructions in logging out of MMIS.

Because of Data Privacy laws, you are strongly encourage to obtain
permission from your supervisor to select a recipient in order to
view their claims for training purposes.
                 Claims Subsystem
The Claim Subsystem uses information from all other subsystems to
determine if a claim should be paid and how much to pay. Claims
are submitted to MMIS either by paper and mailed to the Department
for scanning, or by modem through the ITS (Information Transfer
System). A user can view up to three years of claims history.

To enter into the Claim Subsystem, locate its name on your Main
Menu, use your Enter Key to move to that line, and place an “x” in
front of the line. Use your Transmit Key.
                      Claims Subsystem
07/16/04 9:50:49       MMIS MAIN MENU - MAIN PROD                    DY00 PWMW000
             *** MEDICAID MANAGEMENT INFORMATION SYSTEM ***
SEL                                          SEL
 CLAIMS PROCESSING APPLICATIONS:             OTHER APPLICATIONS (CONT.):
X INQUIRY                                    TPL RESOURCE FILE APPLICATION
 REFERENCE FILE APPLICATIONS:                RECIPIENT MISCELLANEOUS FUNCTIONS
  PROC, DRUG, DIAG, DRG, UPC                 MANAGED CARE
  RATES
  EXCEPTION CONTROL
  TEXT
  SYSTEM PARAMETERS/LIST PARAMETERS
 PRIOR AUTHORIZATION APPLICATIONS:
  PRIOR AUTHORIZATION
  SCREENINGS
 OTHER APPLICATIONS:
  PROVIDER FILE APPLICATION
  RECIPIENT FILE APPLICATION
  TPL BILLING APPLICATION
  MISCELLANEOUS FUNCTIONS
  SECURITY ADMINISTRATION
  FINANCIAL CONTROL
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
                   S/EXT             N/EXT                    OOPS
                 Claims - Keypanel Screen
The Keypanel Screen lists the criteria you can use to identify a claim to view.

Section #1. It is best to place an “X” in front of “All Claims” in order to get a complete
search.

Section #2. Putting the claim Transaction Control Number (also known as the document
control number) in this section will bring you directly to that claim. Otherwise, use the
Provider Number or Recipient ID number (but not both).

Section #3. This section is not mandatory, but it will narrow the search for claims for the
recipient or provider that was identified in section #2. More than one field can be valued.

Section #4. The search will default to a summary screen listing all the claims that match the
criteria in Sections 1 – 3 and you can chose which of the claims you want to review. By placing
a “D” here, you will receive each claim one at a time.

When finished, use your Transmit Key.
      Claims - Keypanel Screen
NEXT:       07/16/04 09:40:23 MMIS CLM INQ KEY PNL-CINQ               PWMWC90
1. ENTER AN "X" BESIDE THE DESIRED SELECTION:
   X ALL CLAIMS                 SUSPENDED CLAIMS
    TO BE PAID/TO BE DENIED CLAIMS       CLAIMS HISTORY

2. ENTER ONE OF THE FOLLOWING KEY FORMATS TO BE USED FOR SEARCH:
  A. TRANSACTION CONTROL NUMBER:
   B. PROVIDER NUMBER:     PAY-TO/SUBMIT: TREAT/CONTRACT:
   C. RECIPIENT ID:

3. ADDITIONAL SEARCH CRITERIA FOR PROVIDER OR RECIPIENT SEARCH:
   PROVIDER NBR:             RECIPIENT ID:
   DATE OF SERV:           PROCEDURE CODE:
   WARRANT DATE:              REVENUE CODE:
   REIMB AMOUNT:               CLAIM TYPE: STATUS:
CATEGORY OF SERV:              MN SERV GROUP:
  EXCEPTION CODE:                  MDC:

4. ENTER THE LEVEL OF DETAIL INDICATOR:
   D = DETAIL S = SUMMARY (DEFAULT) P = PROCEDURE SUMMARY

ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
PAGE               S/EXT             N/EXT                   OOPS
              Claims - CRPC Screen
This Selection Screen appears listing all the claims that met the
criteria shown on the Keypanel Screen. If there is a “+” sign at the
bottom, use the PF7 or PF8 Keys to scroll to other claims.

*Provider Number              The number of the provider on the
                              claim form.
First DOS                     The first date of service.
Last DOS                      The last date of service.
Warrant Date                  The date that the claim was paid.
Reimbursement Amt.            The total amount of money from all the
                              paid line items on the claim.

*Note: if the recipient PMI number was used in Section 2, you will
see a list of provider numbers on this screen. If the provider number
was used in Section 2, you will see a list of recipient PMI numbers.
               Claims - CRPC Screen
Claim Status          The header status of the claim. Each claim
                      needs to be reviewed to see the status of the
                      individual line items. Even though the claim
                      header status may be “paid”, line items may be
                      denied or suspended. If the header status is
                      “denied”, then all the line items will also be
                      denied. Claims statuses are: N=paid,
                      P=denied, S=suspend, I=to be paid at next
                      warrant, K=to be denied at next warrant, B=in
                      process, and X=verifying information.
Claim Type            For waiver and Alternative Care claims, the
                      type will be A = HCFA-1500.
Transaction Control # This is the same as the document control
                      number. It is assigned to each claim by MMIS
                      as a unique identifier.
                Claims - CRPC Screen
To view a claim, use the Arrow Key to move the cursor to one of the
lines. Press the PF4 key. You will be brought to the first detail screen
of the claim. Use the Transmit Key to view all claim screens. Use
the PF3 or PF6 Key to return you to this Selection Screen.

Selecting claims to view from this screen does add a restriction in that
you will not be able to use the PF4 Key on specific fields on the claim
detail screens to navigate to other subsystems to view information
about that field.
             Claims - CRPC Screen
NEXT: 03/13/99 15:40:40 MMIS RECIP PD/DENY - CRPC        PWMW494
RECIP ID: 00000000 LAST NAME: RABBIT    FIRST NAME: BUNNY MI: C
COS:    MSG:      PROC CD:         REVENUE CD:
MDC:      EXC: PROV TYPE:      BILLED AMOUNT:

   PROV                 FIRST LAST WARRANT REIMBURSEMENT
   CLM TRANSACTION #    DOS DOS DATE AMT STATUS CONTROL
01 1111111 00          010198 013098 030298 75.28  N 99999999999999999
02 2222222 00          010698 013198 030298   5.88 N 88888888888888888
03 3333333 00          021898 021898          0.00 K 77777777777777777
04 4444444 00          120197 123197 021798 102.27 N 66666666666666666
05 5555555 00          120197 123097 020298 225.84 N 55555555555555555


To view each claim one at a time instead of using this screen, press the
PF3 or PF6 Key to return you to the Keypanel Screen. Add a “D”
in Section 4 of the Keypanel Screen. Press the Transmit Key. The
first claim will appear.
                   Claims - CHF1 Screen
This is the first detail screen of the claim. Not all fields pertain to waiver/AC claims.
The fields that do are:
Type:                Provider type number.
Provider Number: The pay-to provider.
Recipient ID:        Person’s PMI Number
Major Program: MA = Medical Assistance and AC = Alternative Care
LA:                  The living arrangement from the RLVA Screen. 80 = Community
Warrant Date:        The date the claim was paid.
Replaced by TCN: If this claim was replaced by another claim it shows the document
                     control number here.
Total Reimb. Amt.: Shows the total amount of money paid.

You can view the Recipient Subsystem by pressing the PF4 key when the cursor is on
the Recipient ID field. You can also view additional provider information in the same
manner by placing the cursor on the Provider Number field. Use the PF3 or PF6 Key
to return to this screen. Use the Transmit Key to advance to the next screen.
                     Claims - CHF1 Screen
                          HCFA-1500 - CHF1
NEXT: CHF2 07/16/04 10:07:26                        9999999 07/08/04 PWMWC40
                          TCN: 2 00000 00 000 0000 01
ACCOUNTING CD: 0 NORM-PAY                       CLAIM STATUS: N PAID
                                                LAST CYCLE DT: 070804

PROVIDER NBR: 0000000 00                      TYPE: 45
                          LAST                 FIRST     MI
RECIPIENT ID: 00000000    NAME: ELL              EL       M
     DOB: 01021985 SEX: F AGE: 018 MAJOR PROG: MA      LA: 80
       PAT STATUS EMP:        OTHER INS INFO:
PAT CONDITION RELATED TO EMP:     ACCI:    OTHER ACCI:
      NUMBER OF RIDERS: 0         CARRIER INFO:

OVR LOC:       OVR EOB/EXC:       ATTACH FOUND: TPL BLNG IND:
WARRANT DATE: 071304 REPLACEMENT RSN:       TCN REPLCD:
 OBLIG ID:               REPLCD BY TCN:
WARRANT NBR: 111111111 RA NBR: 000000000 TOT REIMB AMT:   406.62

LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID
000 289 6
289 THE CLAIM'S SUBMITTING PROVIDER IS NOT A VALID BILLING AGENT FOR THE
  PAY-TO PROVIDER. IF A PAY-TO PROVIDER ACTS AS A BILLING AGENT,THAT
                       Claims CHF2 Screen
This is the second detail screen.

DT Curr Ill:                   The date of the current illness
DT Similar Ill:                The date of any similar illness
Ref Prov NBR:                  The ID number and provider number of the referring provider.
Hosp Date From/To:             The dates the patient was hospitalized
Diagnosis Codes:               Up to four diagnosis codes. These codes do not need to match
                               the screening document.
Prior Auth Nbr:                The Prior Authorization (service agreement) number that will be
                               used to price the waiver/Alternative Care claim. You can view
                               the service agreement by moving the cursor to this field and
                               using the PF4 key.
Patient Acct Number:           The provider’s own patient account number.
Total Charge:                  The provider’s total charge for this claim.
Prior Payment:                 This field should always be left blank for waiver/AC claims.
Balance:                       The provider’s total charge minus the prior payment amount.
Date billed:                   The date the claim was received by DHS.
Provider Number:               The Pay-to Provider.

Use the Transmit Key to advance to the next screen.
             Claims - CHF2 Screen
NEXT: CHF3 03/13/99    HCFA-1500 - CHF2 0000032 02/06/99 PWMW441
                   TCN: 2 04190 00 000 0000 01
ACCOUNTING CD: 0 NORM-PAY CLAIM STATUS: N PAID
PROVIDER NBR: 0000000 00                   TYPE: 18
RECIPIENT ID: 00000000                     NAME: Ell       EL       M
DOB: 09291927 SEX: F AGE: 070              MAJOR PROG: A LA:
DT CURR ILL:                               DT SIMILAR ILL:
REF PROV IND:                              REF PROV NBR:
HOSP DATE FROM/TO:                         TRANS DEST IND:
DIAGNOSIS CODES:
PRIOR AUTH NBR: 099999999900               HOSPITAL CERT NBR:
PATIENT ACCT NBR:
TOTAL CHARGE:       406.62
PRIOR PAYMENT AMT:                         BALANCE DUE:      406.62
SIGNATURE: Y                               SECOND SIGNATURE/FACI ADDR:
DATE BILLED: 071504                        PROVIDER NBR: 0000000 00

LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID
ENTER-PF1-PF2-PF3-PF4-PF5-PF6-PF7-PF8-PF9-PF10-PF11-PF12
                           Claims - CHF3 Screen
The last detail screen shows the individual line items. This screen can show two lines. Additional lines are obtained by
moving the cursor (using the arrow keys) to the first line of the line item section and using the PF8 Key. Each line item
will have its own status, so there can be a combination of approved, pend, suspend, or denied lines.
Service Dates:             This is the period that the service was provided.
Place of Service:          Identifies the place where the service was provided.
Type of Service:           This field is left blank for waiver/AC claims.
Procedure:                 The HCPC or procedure code that identifies the service. View additional information by placing
                           the cursor on this field and using the PF4 key.
MOD1 - 4:                  Modifiers used to price the service.
Diagnosis:                 The number of the diagnosis(es) from the previous screen ( 1 – 4)
Charges:                   The provider’s usual and customary charge for the service.
Units                      The amount of units that were provided during this period.
Treating Plan Provider: The pay-to provider.
PA Number:                 The service agreement or authorization that authorized the payment
Base Rate/Source:          The rate that DHS will allow to be paid. The Source indicates how it was
                            priced. Choices are: AA = priced by authorization (all waiver and AC will use this); PP =
                            priced by the procedure code; or RR = priced by the rate record.
Allowed Units:             The amount of units to be paid. This can be less than what was requested.
MSG:                       Minnesota Service Grouping code. Used for reporting purposes.
Based Rate Change          The base rate for waiver or AC claims may change for one of these reasons: 01= Spenddown;
                           03 = TPL; 05 = SA allowed Amount/Reason: less; 17 = AC Allocation Met; or 18 = EW/SIS
                           Special Income Standard Cut. When this field is indicated, the rate that was paid is the
                           difference between what we allow and what was actually paid.
Provider Type/COS:         The provider type assigned to the provider. The category of service assigned to the procedure
                           code.
Calculated Allowed Charge:               The amount that DHS would allow before any base rate changes.
Reimbursement Amount/Status:             The actual amount being reimbursed to the provider and how it was paid.
                                         B = billed amount or A = allowed amount. If the billed and allowed amounts are
                Claims - CHF3 Screen
NEXT: CHF1 07/16/04 10:24:16   HCFA-1500 - CHF3 9999999 07/08/04 PWMWC42
                    TCN: 2 00000 00 000 0000 01
ACCOUNTING CD: 0 NORM-PAY                                     CLAIM STATUS: N PAID
PROVIDER NBR: 0000000 00                   TYPE: 45           RECIP ID: 00000000

START LINE NBR: 001 MAX LINES: 1
 SERVICE DATES     PLC TYP    --MODIFIER-      SUBMITTED DAYS/ FAM
LI FROM TO         SVC SVC PROC 1 2 3 4 -DIAG-- CHARGES UNITS PLAN
001 032404 032404  99       X5263                  406.62     1
TREAT PROVIDER: 0000000 00 PA NBR: 000000000000
OVR EOB/EXC:      BASE RATE/SRC: 406.62 AA ALLOW UNITS: 1 MSG: 512
  BASE RATE CHNG AMT/RSN:               PROV TYPE/COS: 45 097
CALC ALLOW CHG: 406.62 REIMB AMT/STAT: 406.62 B LA: 80 FUND CD: 099

002
TREAT PROVIDER:            PA NBR:
OVR EOB/EXC:        BASE RATE/SRC:            ALLOW UNITS:         MSG:
  BASE RATE CHNG AMT/RSN:                        PROV TYPE/COS:
CALC ALLOW CHG:             REIMB AMT/STAT:             LA: FUND CD:
LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID
000 289 6
289 THE CLAIM'S SUBMITTING PROVIDER IS NOT A VALID BILLING AGENT FOR THE
  PAY-TO PROVIDER. IF A PAY-TO PROVIDER ACTS AS A BILLING AGENT,THAT
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
PAGE HELP      S/EXT NAVIG SLIST N/EXT PREV NEXT        OOPS
                      Replacement Claims
A provider will need to submit a replacement claim in these situations:

1) When they mistakenly bill at a lower rate than what is shown on the
line item. Provider then bills for the rate they need (not the difference).

2) When the provider bills for more units or money than what is on the
line item.When this happens, the LTC provider will have his claim cut back to as
many units or money that is left on the line item. The units or money on the line
item needs to be increased. The provider can then submit a replacement claim for
the entire amount that is needed (not the difference).

3) When the service agreement line item authorized rate is incorrect (less than the
correct rate) and a claim was paid against the line item.
              Replacement Claims
To submit a replacement claim:
1. Another paper or ITS claim form is submitted
2. List the TCN (claim ID number) of the paid claim that
   had errors and will be replaced. Use replacement reason
   code “406".
3. The DHS Claims Processing Division takes back the
   previously paid claim and re-processes the replacement
   claim. Monies may or may not change hands depending
   on this step.
                        Credit Claims
A credit claim is necessary for the following instances:
1) when the wrong rate is approved on the service agreement line item
    and the correct rate is higher; and
2) when the wrong provider number was used (because the agency has
    more than one provider number).
The provider may mail or fax a copy of the credit request to the Benefit
Recovery unit. Processing the request allows the paid units and money on
the line item to be removed. The county case manager will “shut down”
the line item and create a new approved line item with the correct rate (or
provider). The provider will receive a service agreement showing these
changes and may now re-bill for the rate that is needed (not the
difference).
                Credit Claims
To submit a credit:
•    Do not submit a paper claim form or MN-ITS.
•    The DHS Benefit Recovery Section is notified of the
     TCN (claim ID number) listed on the Remittance Advice
     form that needs to be credited.
•    Monies can be returned by check or withheld from a
     future warrant.
•    A check with a copy of the RA that highlights the paid
     claims(s) and an explanation for the refund should be
     sent to: DHS Benefit Recovery, P.O. Box 64836, St.
     Paul, MN 55164-0836. Or, to send just a copy of the
     RA for a credit adjustment, mail to DHS Benefit
     Recovery, 444 Lafayette Road, St. Paul, MN 55155-
     3850. The fax number for the DHS Benefit Recovery
     Section (BRS) is (651) 296-9438. Their phone number
     is 800-657-3963 or (651) 296-9938.
                Claims Over 365 Days
Claims must be in a status of “to-be-paid” or “paid” within 365 days
of the service date. If the paid claim was “cut-back” (such as an
amount
reduced because the county does not have adequate AC allocations to
pay
the claim - base rate change #17) the provider must re-bill within the
remainder 365 day period, or six months from the warrant date of the
original paid claim, whichever is longer. If either the county, state or
federal worker caused the delay or err when working with a file, the
provider can be allowed a “window” of six months from the
documented date of correction to rebill the claim. In all these cases,
the re-billed claim should be sent to “Attn: Claims Supervisor” at mail
code 3849 with documentation of the initial paid claim, and the
correction made by county or state staff.
                        Billing Agents
While providers submit claims directly to the Department for processing,
county agencies may act as a “billing agent” for smaller or one-time
vendors by submitting the vendor’s claims to the Department. In either
method, reimbursement is then paid directly to the provider. While
county agencies may charge a fee for their services, and these costs may
be factored into the unit rate for the service, the costs may not be charged
to the waiver program as a separate unit of service. The county would
be enrolled as provider type 98 for this purpose only.
                    Claim Histories
MMIS holds three years of paid and denied claims. Paper claim
histories for a period older than the last three years can be obtain by
completing the MMIS II Recipient Claims History Profile Request
form and sending it to DHS for processing. Call (651) 215-1146 for
a copy of this form.

Now that you are finished with the Claims Subsystem, use the PF3
or PF4 Key to return to the Main Menu Screen.
                            Mini Test
•   What types of questions can be answered from the Claims Subsystem?
•   If you view the claims through the Summary Screen (CRPC) how are you
    restricted?
•   When viewing individual claims, you can use the PF4 Key to navigate to other
    subsystem. Which fields will allow you to navigate to which subsystems?
•   The amount submitted may be different from the amount that is paid. This
    difference is determined by the Base Rate Change Amount reason. What are
    the four reasons that a payment may be lowered?
•   What situations will cause a provider to submit a replacement claim?
•   How is a replacement claim submitted to DHS?
•   What situation will cause a provider to submit a credit claim?
•   How is a credit claim submitted to DHS?
•   Explain what happens when a claim is submitted beyond the 365 day period
    when the service was provided.
   LTC Screening Documents
The LTC screening document records county preadmission
screening of all persons entering certified nursing or
certified boarding care facilities as required under
Minnesota Statutes, 256B.0911 (PAS) and under federal
OBRA legislation (Public Law 101 and 103).

The document is also used to record assessment and
program eligibility determination information for persons
served under the nursing facility level of care waiver
programs, the Alternative Care (AC), and MnDHO
programs.
In addition, case managers use this form for certain program
administration activities such as reassessment, closures, and program
changes.

The LTC screening document provides an important link between
assessment and eligibility determination, recipient information, and
services authorization and payment through a variety of edits
exercised in MMIS.

Because this document plays a critical role in establishing payments
for a variety of long term care services, including nursing facility
services, each county agency must ensure timely submission of the
LTC screening document information into MMIS. It is strongly
recommended that no more than fourteen (14) calendar days lapse
between completion of any LTCC or case management activity and
the submission of the data into MMIS.
      Prior Authorization Subsystem
To enter into Screenings, locate its name on your Main Menu, use your
Enter Key to move to that line, and place an “x” in front of the line. Use
your Transmit Key.

11/22/00 11:37:02 MMIS MAIN MENU - MAIN PROD DY00 PWMW000
       *** MEDICAID MANAGEMENT INFORMATION SYSTEM ***
            SEL                                         SEL
 CLAIMS PROCESSING APPLICATIONS:            OTHER APPLICATIONS (CONT.):
 INQUIRY                                    TPL RESOURCE FILE APPLICATION
 REFERENCE FILE APPLICATIONS:               RECIPIENT MISCELLANEOUS FUNCTIONS
                                            MANAGED CARE
  PROC, DRUG, DIAG, DRG, UPC
  RATES
  EXCEPTION CONTROL
  TEXT
  SYSTEM PARAMETERS/LIST PARAMETERS
 PRIOR AUTHORIZATION APPLICATIONS:
  PRIOR AUTHORIZATION
X SCREENINGS
 OTHER APPLICATIONS:
  PROVIDER FILE APPLICATION
  RECIPIENT FILE APPLICATION
  TPL BILLING APPLICATION
  MISCELLANEOUS FUNCTIONS
  SECURITY ADMINISTRATION
  FINANCIAL CONTROL
ENTER--PF1---PF2--PF3--PF4---PF5--PF6---PF7--PF8--PF9--PF10---PF11--PF12
         Screenings - Keypanel Screen
To view a screening document, use an “I” in the Action Code field, an “L”
for LTC Documents or “D” for DD documents (or leave blank) in the
Document Type section, and use either the PMI number or document
control number. Section #2 is optional to limit your search by a span or
document status.

            NEXT:    03/12/98 12:54:34 MMIS SCRNG KEY PANEL-ASCR           PWMW901

 ACTION CODE:                                                           DOCUMENT TYPE:
A=ADD     C=CHANGE   I=INQUIRY                                           D=DD L=LTC
B=BATCH ENTRY D=DELETE                                                  P=PCI C=C&TC

1. ENTER THE APPROPRIATE PRIMARY KEY FORMAT:
    DOCUMENT NUMBER:
    RECIPIENT ID:
    CASE MGR/PROV NBR:        (INQUIRY ONLY)

2. ADDITIONAL SEARCH CRITERIA FOR RECIPIENT OR CASE MGR/PROV SEARCH:
       START DATE:
        END DATE:
         STATUS:        (A=APPROVED D=DENIED S=SUSPENDED)
           LOC:       USER ID:
   ***************************************************************************************************
    * ALT1 - LTC SCREEN 1              ALT2 - LTC SCREEN 2                   ALT3 - LTC SCREEN 3 + *
    * ALT4 - LTC SCREEN 4              ADD1 - DD SCREEN 1                    ADD2 - DD SCREEN 2    *
   ***************************************************************************************************
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF1
 Keeper and Non-Keeper PMI Numbers

The recipient may have more than one PMI
number by mistake. Only one number can be the
active or “keeper” number. This is shown on the
Selection Screen at the top with an “A”. Any other
PMI number(s) will not have continued eligibility
and are known as “non-keeper” numbers. These
numbers are listed on the Selection Screen at the top
as “ALT RECIP IDs”.
           Screenings - Selection Screen
If the person has more than one screening document, you will see a listing of the
documents on the Selection Screen. Use the Tab key to move down the line of
documents and place an “x” in front of the line you wish to view.
NEXT:    07/16/04 11:00:54 MMIS SCRNG SELECTION-ASEL            PWMW902

RECIP ID: 000012345 A                     ALT RECIP IDS: 00345600
 SEL     DOCUMENT       PROVIDER      PROVIDER              ACT              START END MAJ
IND     TYPE NUMBER NUMBER            TYPE    NAME          TYPE ST          DATE DATE PROG
           L 00000000000 6666666      00 AMY K NELSON       13     A         121401
           L 00000000000 6666666      00 AMY K NELSON       10     A         060101     M
           L 00000000000 6666666      00 AMY K NELSON       23    A          032301
           L 00000000000 6666666      00 AMY K NELSON       13    A          110101
           L 00000000000 6666666      00 AMY K NELSON       13    A          110200     A
           L 00000000000 6666666      00 AMY K NELSON       01   A           101500     A

                                                                                              +
ENTER-PF1---PF2- --PF3---PF4---PF5---PF6---PF7--PF8--PF9--PF10--PF11--PF12


Document Type is L for LTC and D for DD
Provider Number and Name is the Case Manager on the document
Action Type is the Assessment Result
ST is the document status: A = approved, S = suspend, D = denied, and R = replaced
Start Date is the Assessment Result Date
Maj Prog is the Major Program associated with the document.
                 Screenings - ALT1 Screen
The first screen of the LTC Screening Document matches Section A of the paper
screening document form. You can use the PF4 key to travel to the Recipient Screens, or
while the cursor is on the diagnosis fields to view the diagnosis information, on the provider
field to view the case manager information or on the edit number(s) to view information
about why the edit is posting. Use the Transmit Key to advance to the next screens.

NEXT: ALT2 08/17/00 13:57:28            MMIS LTC SCREENING - ALT1                           08/17/00 PWMW935
                                         DOCUMENT NBR: 0000 000 0 000
DOC STAT:                                                   CURR LOC/DT:                     OVERRIDE LOC:
CLIENT NAME/ID:                                     00862719                                   REF NBR:

DATE SUB:                  DOB:           SEX:              REF DATE:                 AGE:              LA:

ACTIVITY TYPE:                 ACT DT             COS:         COR:            CFR:              PAS:

LEGAL REP STAT:                         PRIMARY DIAG:                        SECONDARY DIAG:
MR/RC DIAGNOSIS HISTORY:                 MR/RC DIAGNOSIS:
MI DIAGNOSIS HISTORY:                    MI DIAGNOSIS:
TBI DIAGNOSIS HISTORY:                   TBI DIAGNOSIS:
CM/HP NAME:                                                                  CM/HP NBR:

LI EXC ST USER ID              LI EXC ST USER ID                 LI EXC ST USER ID               LI EXC ST USER ID
ENTER-PF1--- PF2--- PF3--- PF4--- PF5--- PF6--- PF7--- PF8--- PF9--- PF10--- PF11--- PF12
              Screenings - ALT2 Screen
The second screen of the LTC Screening Document matches Section B of the paper
screening document form.

NEXT: ALT3 08/17/00 14:33:22   MMIS LTC SCREENING - ALT2               08/17/00
                                DOCUMENT NBR: 0000 000 0 000
DOC STAT:                                 000000000               AGE/LA:

PRESENT AT SCRNG:



MARITAL STATUS:                              REASONS FOR REF:

CURRENT LA:           PLANNED LA:                 TEAM:                HOSP TRNF:
OBRA LVL 1 SCR:       PAS 30 DAY:                  CURR HOUSING:          OTHER:
PLANNED HSNG:           OTHER:            OBRA LVL 2 REF:            TBI/CAC REF:

LI EXC ST USER ID      LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID
ENTER-- PF1--- PF2--- PF3--- PF4--- PF5--- PF6--PF7--PF8--PF9--PF10--PF11--PF12
                  Screenings - ALT3 Screen
The third screen of the LTC Screening Document matches Section C of the paper
screening document form.
NEXT: ALT4 08/17/00 14:35:53        MMIS LTC SCREENING - ALT3                                 08/17/00 PWMW9
                                        DOCUMENT NBR: 0000 000 0 000
DOC STAT:                            00000000                                    AGE/LA:

DRESSING:                  GROOMING:                  BATHING:                   EATING:                 BED MOB:
TRANSFER:                  WALKING:                   BEHAVIOR:                  TOILET:                 SPC TRMT:
CL MONITOR:                NEURO DX:                  CASE MIX:                  ORIENT:                 SLF PRES:
DIS CERT:                  SLF EVAL:                  MENT ST EV:                TEL ANS:                TEL CALL:
SHOPPING:                  PREP MLS:                  LT HOUSE:                  HY HOUSE:               LAUNDRY:
MGMT MEDS:                 MONEY MT:                  TRANSP:                    FALLS:                  HOSP:
ER VISITS:                 NF STAYS:

LI EXC ST USER ID         LI EXC ST USER ID                         LI EXC ST USER ID         LI EXC ST USER ID
ENTER-PF1--- PF2--- PF3--- PF4--- - PF5--- PF6--- PF7--- PF8--- PF9--- PF10--- PF11--- PF12
                 Screenings - ALT4 Screen
The fourth screen of the LTC Screening Document matches Sections D, E , and F of
the paper screening document form.

NEXT: ALT5 08/17/00 14:37:45  MMIS LTC SCREENING - ALT4                                     08/17/00 PWMW
                               DOCUMENT NBR: 0000 000 0 000
DOC STAT:                                            00000000                               AGE/LA
ASSESSMENT RESULTS/EXIT RSNS:            ASSESSMENT DT:

INFORMED CHOICE:                CLIENT CHOICE:                                 FAMILY CHOICE:
PAS/IDT RECMND:                 RISK STATUS:                                   QA/R NBR:
CASE MIX/DRG:        CASE MIX APP (Y/N):                          MNDC:
REASONS FOR INSTITUTIONAL STAY:

ADL COND:                   IADL COND:                   COMP COND:                 COGNITION:          BEHAVIOR:
HYG/SAFETY:                 NEG/ABUSE:                   FRAILITY:                  SENSORIAL:          REST/REHAB:
UNSTABLE:                   SPEC TREAT:                  CMPLX CARE:

REQUIRES AC/WVR SVC:                   SAFE/COST EFFECTIVE:                    NO OTHER PAYOR IS RESP
PROGRAM TYPE:                                                                  MnDHO RCC

LI EXC ST USER ID     LI EXC ST USER ID        LI EXC ST USER ID       LI EXC ST USER ID
ENTER-PF1--- PF2--- PF3--- PF4--- PF5--- PF6--- PF7--- PF8--- PF9--- PF10--- PF11--- PF12
                 Screenings - ALT5 Screen
The fifth screen of the LTC Screening Document matches Section G of the paper
screening document form.

NEXT: ADHS 08/17/00 14:39:21 MMIS LTC SCREENING - ALT5                                      08/17/00 PWMW93
                               DOCUMENT NBR: 0000 000 0 000
DOC STAT:                                00000000                                           AGE/LA:

CODE IND DESCRIPTION                                  CODE IND DESCRIPTION




LI EXC ST USER ID          LI EXC ST USER ID           LI EXC ST USER ID          LI EXC ST USER ID
ENTER-PF1--- PF2--- PF3--- PF4--- PF5--- PF6--- PF7--- PF8--- PF9--- PF10--- PF11--- PF12
                  Screenings - ALT6 Screen
The sixth and last screen of the LTC Screening Document matches Section H of the
paper screening document form. This screen only appears if the program type on
the ALT4 Screen is Alternative Care (09, 10, or 22) or Consumer Support Grant (13
or 14).

    NEXT: ADHS 07/16/04 11:12:50 MMIS LTC SCREENING - ALT6     X17940 1 04/21/99 PWMW949
•                        DOCUMENT NBR: 0230 900 0 009
•      DOC STAT: A APPROVED                                    00862719    AGE/LA:

•      STREET ADDRESS:
•      STREET ADDRESS:
•          CITY:                     STATE:        ZIP CODE:      CFR:
•
•      GROSS INCOME: 3000                          GROSS ASSETS:   300
•      AC ADJUSTED INCOME:     400                 AC ADJUSTED ASSETS:    300
•
•      MEDICARE ID NUMBER:
•      MEDICARE PART A BEGIN DT:         END DT:
•      MEDICARE PART B BEGIN DT:         END DT:
•
•      AC PREMIUM WAIVER REASON:                   AC LIEN REF:           AC PREM ASSESSED:
Now that you are finished reviewing the LTC
screening document screens, use your PF3 or
PF4 Key to return to the Main Menu Screen.
                Mini Test
• Which fields can you use the PF4 key to
  view additional information?

• When will the ALT6 screen be shown?
             Prior Authorization
             Service Agreements
All Home Care (with some exceptions), waiver, and
Alternative Care services must be prior authorized by
the case manager prior to providing the service. The
service agreement is used by the case manager to
identify the services that the client will be provided, the
time period, number of units, the provider, and the rate
that will be paid. Claims submitted by the provider are
matched against the service agreement information to
determine if the claim can be paid.
             Service Agreements
The service agreement is divided into three parts: General Information,
SCH Data, and Line Items.

The General Information section provides information about the client,
the case manager, the beginning and ending dates of the service
agreement period, the total cost of the services, and the cap amount.

SCH Data was used for the Minnesota Children with Special Health
Needs Program (MSSHN). County staff will not be completing service
agreements for this program and these fields should be left blank.

The Line Item section identifies those services authorized by the case
manager for the person. Each line item identifies the provider, the
service, maximum number of units or dollars, and the period that the
service may be provided.
                       Service Agreements
                       Main Menu Screen
To enter into the service agreement, place an “x” on the line marked Prior Authorization and use your
Transmit Key.
11/22/00 11:37:02           MMIS MAIN MENU - MAIN                 PROD DY00 PWMW000
                  *** MEDICAID MANAGEMENT INFORMATION SYSTEM ***
 CLAIMS PROCESSING APPLICATIONS:     OTHER APPLICATIONS (CONT.):
 INQUIRY                                   TPL RESOURCE FILE APPLICATION
 REFERENCE FILE APPLICATIONS:              RECIPIENT MISCELLANEOUS FUNCTIONS
                                           MANAGED CARE
  PROC, DRUG, DIAG, DRG, UPC
  RATES
  EXCEPTION CONTROL
  TEXT
  SYSTEM PARAMETERS/LIST PARAMETERS
 PRIOR AUTHORIZATION APPLICATIONS:
X PRIOR AUTHORIZATION
  SCREENINGS
 OTHER APPLICATIONS:
  PROVIDER FILE APPLICATION
  RECIPIENT FILE APPLICATION
  TPL BILLING APPLICATION
  MISCELLANEOUS FUNCTIONS
  SECURITY ADMINISTRATION
  FINANCIAL CONTROL
                Service Agreements
                 Keypanel Screen
The Keypanel screen is used to identify the service agreement you
wish to view. Select an “I” for the Action Code field. You can
leave the Authorization Type and Agreement Type fields blank in
order to view all types for the client. Otherwise, place a “T” in the
Authorization Type field and either B, or F - Q in the Agreement
Type field to narrow the search to a specific type of service
agreement.
Identify the service agreement either by the authorization
number or PMI number.
Section 2 is optional and will allow you to limit the search by a date
span or a status. Use the Transmit Key when finished.
                     Service Agreements
                      Keypanel Screen
NEXT: 03/12/98 10:12:59           MMIS PA KEY PANEL - AKEY
ACTION CODE:                            AUTHORIZATION TYPE:
A=ADD    C=CHANGE         I=INQUIRY     D=DENTAL     P=PHARMACY B=BATCH ENTRY
D=DELETE                                M=MEDICAL S=SUPPLY
                                        T =SVC AGMT      AGMT TYPE:

1. ENTER ONE OF THE FOLLOWING KEY FORMATS:
       AUTHORIZATION NUMBER:         COPY FROM:
       RECIPIENT ID:
       PROVIDER NUMBER:

2. ADDITIONAL SEARCH CRITERIA FOR RECIPIENT OR PROVIDER SEARCH:
        START DATE:
        END DATE:
        STATUS:
   (FOR SUSPENSE RESOLUTION) LOC:              USER ID:
ENTER--PF1--PF2--PF3--PF4--PF5--PF6--PF7---PF8---PF9---PF10---PF11--PF12
           Service Agreements
            Selection Screen
If there are more than one authorization you will
be shown the Selection Screen that lists all the
prior authorizations for the client. If the Type
field shows “T - __” that is a service agreement.
The status can be A = approved, T = partially
approved, S = suspended, D = denied, and P =
pended. The Start and End Date fields show the
period of time the service agreement covers.
Select one by placing an “x” in front of the line.
Use your Transmit Key.
               Service Agreements
                Selection Screen
NEXT:   07/12/02 12:16:46 MMIS PA SELECTION - ASEL            PWMW902
 RECIP ID: 00000000  PROV NBR:      START DT:     END DT:
 AGMT TYPE: T                                  STAT:
SEL AUTH PROVIDER PROVIDER       ACT          START END         MAJ
IND TYPE NUMBER TYPE NAME        TYPE ST      DATE DATE         PROG
     T-J 00000000000                  T       030102 083102     MA
     T-J 11111111111                  A       030101 022802     MA
     T-J 22222222222                  A       030100 022801     MA
     T-J 33333333333                  A       030199 022900     MA
     T-J 44444444444                  A       031898 022899     MA
          Service Agreements
             ASA1 Screen
The first screen contains information about the period
the service agreement covers, the amount of money that
is available, and recipient demographics. The case
manager and county(ies) involved are identified.

Continue to use your Transmit Key to advance to the
next screens.
                      Service Agreements
                         ASA1 Screen
NEXT: ASA2 07/12/02 12:24:27       MMIS SERVICE AGMT - ASA1         PWMW941 06/2
                                    AUTHORIZATION NBR:
AGMT STAT:                                                 CURR LOC/DT:
AGMT TYPE:                                                 AGMT START/END DT:
PROV NBR/NAME:
REF PROV NBR:                            TOT AUTH AMT:                  CAP AMT:

LAST                           FIRST         MI
RECIP NAME:                                                 RECIP ID:              SEX:
DOB(MMDDYYYY):                                    AGE:                  LA:        MAJ PROG:
CM NBR/NAME:
         CO OF SVC:             CO OF RES:        CO OF FIN RESP:

DISC FUND(Y/N):                 AUTH DATE:                  AUTH SIG(Y/N): Y
SCH EVAL/TRMT:                                              MSG 1/2/3:
DIAG RANGE 1 FR:                                            DIAG RANGE 1 THRU:
DIAG RANGE 2 FR:                                            DIAG RANGE 2 THRU:
AVG MO AUTH AMT:                                            AVG DAILY AUTH AMT:
TOT USED UNITS:                                             TOT USED AMT:
            Service Agreements
               ASA2 Screen
The ASA2 screen:
• allows up to four reason codes that adds special
messages onto the service agreement letters;
•identifies if a service agreement letter was mailed to
the recipient;
•identifies the AC premium amount (if any) assessed to
the recipient and the effective date; and
•whether there is a responsible party or fiscal
intermediary when the person is receiving PCA
services.
                     Service Agreements
                        ASA2 Screen
NEXT: ASA3 07/16/04 11:20:43 MMIS SERVICE AGMT - ASA2      07/16/04 PWMW926
                    AUTHORIZATION NBR:

AGMT TYPE/STAT: J S SUSPENDED                      PROV NBR/TYPE:
RECIP NAME/ID:                      SEX: AGE/LA:

  STAT RSN:                            SEND RECIP LTR(Y/N):
 ATTACH(Y/N):                          SEND PROV LTR(Y/N): Y
 SACTAD NBR:

   OVR LOC:                        AC PREMIUM AMOUNT:
                          PREMIUM EFFECTIVE DATE (MM/YY):
CLAIMS UPDT DT:                    PROV COMMENTS: N
INPUT MEDIA: 0 EXAM ENTRY          RECIP COMMENTS: N
RESP PARTY(Y/N):                   DHS COMMENTS: N
FISCAL INT(Y/N):          LIVES WITH RESP PARTY(Y/N):



LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID
                   Service Agreements
                      ASA3 Screen
The ASA3 Screen identifies the services that were authorized to be provided to
the recipient. While there are 99 line items, only two show on each page. Use
the PF7 and PF8 keys to view other line items, or enter the number of the line
item you wish to view in the LineNav field and press the Transmit Key.

The name of the service (HCPC number), period of time, modifiers, negotiated
rate, number of units, and provider number is shown for each line item.

When claims are paid against the line item the Total Used Units/Amounts fields
shows the number of units used and the total amount paid.

The line item may have a status of A= approved, S = suspended, P = pended, or
D = deny. Additional reason codes can be added to add messages to the service
agreement letter that explain the changes made to the line item. A repeat field is
used to copy the line item during data entry.
                   Service Agreements
                      ASA3 Screen
NEXT: ADHS 07/16/04 11:26:12 MMIS SERVICE AGMT - ASA3      07/16/04 PWMW927
                               AUTHORIZATION NBR:
AGMT TYPE/STAT: J S SUSPENDED                     PROV NBR/TYPE:
RECIP NAME/ID:                       SEX: AGE/LA:
LINENAV: 00
LI COMMENTS/PROCEDURE DESCRIPTION PROC MOD1-4               REV CD
01
                                                  START/END DT:
 REQ RATE/UNIT:              REQ TOT UNITS/AMT:
 PROV NBR/NAME:                                                       SHR/FREQ:
 APP RATE/UNIT:        SRC: TOT USED UNITS/AMT:
  STAT CD/DATE:                         RSN CD:                       REPEAT:
02
                                                  START/END DT:
 REQ RATE/UNIT:              REQ TOT UNITS/AMT:
 PROV NBR/NAME:                                                       SHR/FREQ:
 APP RATE/UNIT:        SRC: TOT USED UNITS/AMT:
  STAT CD/DATE:                         RSN CD:                       REPEAT:
 Screening Document and Service
  Agreement Comment Screens
There are three Comment Screens for each
screening document or service agreement for the
case manager to add additional information.
Text placed on the Provider or Recipient
Comment Screens for service agreements will be
placed on the service agreement letters. The PF2
key will copy the message from one screen to the
next comment screen.
            Logging Out of MMIS
To leave MMIS, use the PF3 or PF6 Key until you reach the Main
Menu Screen. Use the PF Key once more and on the screen shown
below, type LOGOFF (one word over the top of the first line). Press
the Transmit Key.

MMIS SESSION TERMINATED

				
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posted:9/22/2011
language:English
pages:147