HIP Member Debt Process February 2012

Agenda Overview of HIP member debt How it’s reported How it’s cleared How the 834 responds PRF layout 834 sample Q&A

Overview of HIP member debt For members terminated from HIP before their POWER Account is fully funded, the MCE may register and collect any debt owed by the member to the MCE. The MCE registers the debt with the State fiscal agent using the PRF Termination transaction. The State fiscal agent documents the debt owed and the MCE to whom the debt is owed. Neither DFR nor ICES receives or stores this information. Time passes and the former HIP member reapplies for the program.

HIP member debt continued A conditional 834 record generates to the debt plan with an INS03 value of 025 and an INS04 value of 27. The MCE must send a letter to the individual explaining that until his or her debt is paid, the individual cannot participate in HIP and has 60 calendar days to clear the debt and pay his or her first POWER Account contribution. If the MCE collects the debt, it must notify the State fiscal agent that the debt is cleared. This allows an 834 conditional record to generate to the receiving plan, for the member to follow through the reenrollment process. MCEs should clear the debt using the PRF “D” Debt transaction. Debt clear date must be specified in a CCYYMMDD format. If the member does not pay or clear their debt after 60 days, the MCE must submit a no-pay response on the daily Pay/No-pay file. This will terminate the conditional eligibility process for the member.

Member Rollover Same plan or different plan Claims Only Reporting CAT HIP PRF excerpts Field Defaults Type Length Start Finish Format Description/Values Member Plan Change Member Termination Member Rollover Same plan or different plan Claims Only Reporting CAT Member Debt Cleared Debt Incurred Amount 0000000.00 NUMBER 10 119 128 9.2 N/A The TOTAL amount of debt incurred by member as of the 180th day. (If the termination is NOT due to non-payment or member requests termination, then use the default for this field.) Date Debt Amount is sent to HP zeros 8 129 136 CCYYMMDD Date the debt transaction was created. (If the termination is NOT due to non-payment or member requests termination, then use the default for this field.) Debt Cleared Date 137 144 Plans will report this only on "D" type transaction. Default is zeros. Date debt was cleared

PRF field descriptions for debt Debt Incurred Amount 0000000.00 NUMBER The TOTAL amount of debt incurred by member as of the 180th day. (If the termination is NOT due to non-payment or member requests termination, then use the default for this field.) Date Debt Amount is sent to HP zeros NUMBER CCYYMMDD Date the debt transaction was created. (If the termination is NOT due to non-payment or member requests termination, then use the default for this field.) Debt Cleared Date zeros NUMBER CCYYMMDD Plans will report this only on "D" type transaction. Default is zeros. Date debt was cleared.

834 transaction – Maintenance Code INS03 875 Maintenance Type Code O ID 3/3 Required 1 Description: Code identifying the specific type of item maintenance IHCP HIP NOTE Maintenance Type Code 001 – Change 021 – Addition 024 – Cancellation or Termination 025 - Reinstatement 030 – Audit or Compare 1. The monthly audit file consists of only 030. 2. 001 – A change to the member demographic data, power account amounts, eligibility dates, or capitation category. 3. 021 – A new conditionally eligible member, a member who has moved from conditionally to fully eligible, or a member who has moved from one plan to another. Type of eligibility will be sent in INS04. 4. 024 – A member who is being removed from the HIP plan. Can be conditionally or fully eligible. Reason for removal will be sent in INS04. 5. 025 – A conditional member who has an outstanding debt from a previous HIP enrollment. Notification sent to debt plan only. CodeList Summary (Total Codes: 123, Included: 5) Code Name 001 Change 021 Addition 024 Cancellation or Termination 025 Reinstatement 030 Audit or Compare

834 transaction – Maintenance Reason Code INS04 1203 Maintenance Reason Code O ID 2/3 Situational 1 Description: Code identifying the reason for the maintenance change IHCP HIP NOTE This code clarifies the type of change and distinguishes a change from a deletion. The following codes will be used in the 834 file for conditionally eligible members: Maintenance Reason Code 03 - Death 14 – Voluntary Withdrawal 22 – Plan Change 25 – Change in Identifying Data Elements 27 – Pre-Enrollment 33 – Personnel Data 43 – Change of Location XN – Notification Only 03 – Will be sent along with INS03 = 024 to indicate a member who has passed away. Member date of death will be sent in INS12. 14 – Will be sent along with INS03 = 024 to indicate a member who withdrew from HIP prior to making an initial POWER account contribution. 22 – When sent with INS03 = 024, indicates a member no longer eligible for this plan due to a plan change to ESP or another HIP plan. When sent with INS03 = 021, indicates a member coming from the ESP plan or another HIP plan. 25 – Indicates a change has been made to the member’s name, SSN, date of birth, or RID. 27 – When sent with INS03 = 021, indicates a new conditionally eligible HIP member. When sent with INS03 = 025, indicates a conditionally eligible HIP member who was previously on HIP and has an outstanding member debt. 33 – Indicates a change to the member’s POWER account contribution amount. 43 – Indicates the member’s address, phone number, secondary phone number, case number, companion case number, email address and /or PMP directory indicator has changed. XN – Sent along with INS03 = 030 for all monthly audit records.

834 conditional record sample INS*Y*18*025*27*A***FT**Y~ REF*0F*XXXXXXXXXXXX~ REF*1L*HIP~ REF*23*102XXXXXXX~ REF*ZZ*XXXXXXXXXXXX~ DTP*300*D8*20120210~ NM1*IL*1*SMITH*XXX*A***34*305XXXXXX~ PER*IP**TE*8125551111*EM*EMAIL@YAHOO.COM*HP*8125555555~ N3*1 W COUNTY ROAD 1 S~ N4*ANYWHERE*IN*XXXXX~ DMG*D8*19780101*M**7~ AMT*C1*348.04~ AMT*D2*207~

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