1 Business Objects CCS PAID CLAIMS REPORTING

2 Under the new (E47) CCS Service Authorization Process 1.The County Case Manager generates a Service Authorization 2.The Provider enters the Service Authorization Number on their claim

3 This new process has increased our need for Post-payment monitoring

4 Examples of what you have asked to see: Expenditures by Case Provider Diagnosis Procedure Code Funding Source Medi-Cal CCS-only Healthy Family

5 A new CCS claims reporting system is under development Business Objects software will allow users to view historical claims information through a secured WEB site

6 CMS already has three Reporting Systems that operate with Business Objects…

7 1. CCS: Reports from CMS NET Legacy ‘Snapshot’ Updated Nightly Does not contain every data elements in CMS Net Legacy

8 CCS Business Objects includes:  Number of Clients by Status  Caseload by County Case Manager  Client Eligibility  Other Health Coverage  Client Diagnosis (as entered on Patient Registration Screen)

9 2. CHDP: Reports from Claims History July 1, 2002 to present Updated Monthly Includes the CHDP Provider Master File

10 3. CHDP Gateway: Reports from the Gateway Pre-Enrollment Application Form and MEDS July 2003 to present Updated weekly

11 The NEW CCS Claims Reporting System will contain:  12 months of Paid Claims history  Provider Master File  Monthly updates  All data elements carried on the Claim Form

12 Objectives of the New Reporting System  Effective use of program funds  Effective and efficient case management through oversight of CCS program activities  Assessment of outcomes and determination of trends  Quality provision of services (Were the services rendered by CCS- approved providers?)

13 Examples of Reports  Procedure codes paid at the claims detail level (replacement of MR-0-910/940)  Counts and Dollars paid by Provider ID  Services paid under EPSDT SAs

14 Examples (cont.)  Claims by procedure code and CCS ID Number for comparison against Patient’s ICD-9 in CMS Net  Dollars paid by aid code  Summary and Detail MTU reports (CCS provider prefix)

15 To view these reports you will need: 1.Internet Access 2.A Business Objects password from the State

16 Security You will be able to view claims information for children only within your county

17 Step 1 Enter your Business Objects User Name and Password

18 Step 2 Click on the Business Objects ‘LogIn’ Button

19 Step 3 Pick the Reporting System that you want to see

20 Step 4 Click on report title to see the Report

21 Example of a CMS Net Corporate Report

22 Example of a Business Objects Claims History Report

23 Roll-out Phase I Corporate Reports  View and Print  Fixed and Prompted  State staff will create Ad Hoc reports for you

24 Phase II  Link the CMS Net Legacy & CCS Claims Reporting Systems  Link the CCS Claims Reporting system with the Special Care Center SARs

25 Q uestions or Comments?