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 DMH Introduction  Consumer Eligibility Files  VO Data Exchanges with HFS  ProviderConnect Registration ◦ Demo and Error Resolution  Batch Registration ◦ Overview and Submission Process  Viewing Consumer Funds  IT Customer Support ◦ Multiple RIN Resolution  Reporting 2

DMH Introduction Presenter: Mary E. Smith, Ph.D.

 Purpose of Training ◦ Refresher/Review of Key Processes ◦ Availability of Resources and Tools  Registration Design ◦ Data Elements  Use of Registration Data ◦ Decision Support and Planning ◦ Federal Reporting ◦ Ability to look at change across time  Timely Submission of Registrations 4

Presenter: Terry Schoonover

 Recipient Eligibility File  Williams Class Consumer Eligibility File 6

 This File is Sent from HFS to VO ◦ It identifies consumers that have STBO (Social Service B).  Without STBO, the consumer can’t be registered. ◦ It identifies consumers that are Medicaid eligible.  If they are not Medicaid eligible, certain Clinical authorizations will not be approved. ◦ It identifies consumers that are in SASS  If a consumer is in SASS, they can only be registered for a limited amount of funds (currently 121, ICG and ICG Community) 7

 This File is Sent from DMH to VO ◦ Per DMH direction, VO loads each consumer with Williams Eligibility (EWCC fund).  This allows the provider to register the consumer for the Williams Class fund (WCC fund) 8

Presenter: Terry Schoonover

 HFS processes all claims submitted on or after 7/1/2011 (VO does not process these)  Registration, OBRA, and Provider Site funding records must all be accepted by HFS, before a claim can be successfully processed by HFS  In addition to this, a Clinical Authorization must also be accepted by HFS, for services that require authorizations 10

 Consumer Registration  OBRA Codes (reimbursement rate for ABC fund)  Clinical Authorization  Provider Site Fund Codes (funds in which a site is contracted)  MARS File (claims data from HFS) 11

 VO processes registration and assigns funds  VO sends fund information to HFS within 1 business day  HFS processes file (accepts or rejects) and sends results to VO by the 2 nd business day 12 Registration file Registration Response file VO HFS

 When VO processes a registration, an OBRA code is created  The OBRA code represents the rate of reimbursement for claims that pay from the ABC fund (0%, 20%, 40%, 60%, 80%, 100%). It’s based on registration data (income, family size, etc.) ◦ VO sends OBRA codes to HFS within 1 business day ◦ HFS processes file (accepts or rejects) and sends results to VO by the 2 nd business day 13 OBRA file OBRA Response file VO HFS

 VO processes the authorization request  VO sends the approved authorizations to HFS within 1 business day.  HFS processes file (accepts or rejects) and sends results to VO by the 2 nd business day 14 Clinical Auth file Clinical Auth Response file VO HFS

 These are funds that a site has available to use for claims reimbursement (ABC, 821, etc.).  DMH sends site fund code changes to VO.  VO updates the record in the VO system.  VO then forwards the change to HFS, so the HFS system can be updated as well. 15 Site Fund Changes Forwarding Site Fund Changes VO HFS DMH

 After HFS processes a claim, the claim data is sent to VO for reporting purposes. ◦ This data is sent to VO in the “MARS” file 16 MARS file (processed claim data) HFSVO

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 Easily access routine information 24 hours a day, 7 days a week  Complete multiple transactions in a single sitting  View and print information  Reduce calls for routine information  Schedule appointment reminders for consumers 18

 Go to the Illinoismentalhealthcollaborative website.  Click on For Providers  The ProviderConnect Log In will be on the right ◦ All providers will be able to obtain one online log-on per provider ID number via the website ◦ To obtain additional logons for ProviderConnect – contact the Collaborative’s EDI Helpdesk at (888) , Monday through Friday, 7am to 5pm CDT ◦ The turn-around time for additional logons is 48 hours 19

under the Registration Title, sub titled ProviderConnect Registration Guide (December 2011) The registration Process is used to determine a consumers eligibility Obtain a RIN and DHS Social Services (DHS SS) for the consumer through E-Rin System In the Collaborative system Programs are labeled as Funds Please read or reread the guides located at: 20

 Red Dot Error Example 21

 Successful Submission Confirmation Example: 22

Live Demo 23

Batch Registration Presenter: Trish Gorda

Overview Please Note: This portion of the document will step through the basics of submitting a batch registration file using ProviderConnect. For detailed information regarding ….. Submitter ID and Password File Specifications Batch Submission File Layout Error Processing ….. please refer to the Batch Registration Submission Guide found on the Illinois Mental Health Collaborative website.

◦ On the Collaborative Website at:  information.htm 26

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 Reasons for a batch file to be rejected: ◦ Incorrect file format ◦ No trailer record ◦ Trailer record exists but is not formatted correctly  Please Note: Refer to the Batch Registration Submission Guide for detailed information regarding error messages and error file naming conventions. 33

 There could be up to three response files generated for each batch registration file submitted: ◦ Summary File – indicates if the registration file was accepted or rejected. Note: If the batch file is rejected, this is the only response file generated. ◦ Accepted File – contains all registration records that were accepted. ◦ Error File – contains all registration records that were rejected.  Please Note: Refer to the Batch Registration Submission Guide for detailed information regarding response file content, naming conventions, and file layouts. 34

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Presenter: Terry Schoonover

 After a consumer is registered, the funds can be viewed ◦ Start from ProviderConnect Home as seen below 41

 Enter Consumer ID (RIN) and Date of Birth 42

 On the Demographic page, click “View Consumer Registrations” 43

 Funds are listed with date range ◦ To find the ABC benefit package assigned, click the “ILAS” link that corresponds to the ABC fund 44

 There are 3 categories of ABC benefit packages that can pay claims (1 st Presentation, Target, or Eligible) ◦ The First Presentation Indicator and Eligibility Status fields will identify the ABC benefit package that is assigned 45

Eligibility Status & 1 st Presentation Indicator shown in ProviderConnect Benefit Package Assigned Clarification 1 st Presentation Indicated ‘Yes’ABC – 1 st SMI If 1 st Presentation Indicator is ‘Yes’, regardless of Eligibility Status, the “1 st SMI” benefit package is assigned. It covers a larger range of services than an “Eligible” benefit package. (as shown on DMH Service Matrix) Eligibility Status is TADL and 1 st Presentation is ‘No’ ABC – Target Adult Being that 1 st Presentation Indicator is ‘No’, the “Target Adult” benefit package is assigned. A Target benefit package currently covers the same services as 1 st SMI. Again, this covers a larger range of services than an Eligible benefit package. (as shown on DMH Service Matrix) Eligibility Status is TCHD and 1 st Presentation is ‘No’ ABC – Target Child Being that 1 st Presentation Indicator is ‘No’, the “Target Child” benefit package is assigned. A Target benefit package currently covers the same services as 1 st SMI. Again, this covers a larger range of services than an Eligible benefit package. (as shown on DMH Service Matrix) Eligibility Status is ELIG and 1 st Presentation is ‘No’ ABC – Eligible Being that 1 st Presentation Indicator is ‘No’, the “Eligible” benefit package is assigned. An Eligible benefit package covers a smaller number of services than a 1 st Presentation or Target benefit package. (as shown on DMH Service Matrix) 46

Presenter: Terry Schoonover

 This guide is posted to the “In the Spotlight…” section of the Collaborative website at 48 Reason For CallContact Number To Use Claims/Billing Issues before or after 7/1/11 HFS Claims Transition HFS Bureau of Comprehensive Health Services , Press “0”; ask for a Community Mental Health Support Consultant HFS EDI Help Desk: Service Authorization -For a provider to pre-authorize care -Inquire about an existing authorization The Collaborative (866) , select the provider menu, then press 1. Registration questions (technical or nontechnical in nature) Technical difficulty with the Collaborative system such as: - Account disabled - System “freezing” or crashing - System unavailable errors EDI Help Desk (888) Utilization Management (Clinical)The Collaborative (866) , select the provider menu, then press 1. IntelligenceConnect Reporting IssuesEDI Help Desk (888) No RIN or Social Service Package B Issues DHS/Customer Support: Jay Hidalgo (800) Multiple RIN IssuesThe Collaborative (866) , select the provider menu, then press 1. DMH Policy IssuesDMH Regional Staff

 Call the Collaborative at (866) , select the Provider Menu, then press 1 ◦ Collaborative eligibility specialist will then work with DMH ◦ DMH directs the Collaborative to keep or merge each RIN 49