1 Department of Medical Assistance Services 1 Department of Medical Assistance Services MMIS WebEx Training April 2012

2 Department of Medical Assistance Services Agenda MMIS User’s Guide New MMIS User’ Resources DMAS Classroom Training Provider Assistance MMIS Age Edits Member ID Numbers Plan First Smiles for Children Medicaid Works Patient Pay Tips 2 Department of Medical Assistance Services

3 Department of Medical Assistance Services MMIS User’s Guide The following chapters of the MMIS User’s Guide have been updated and are now available to the LDSS: –Chapter A – General Information –Chapter B – Member Screen Layouts –Chapter C – Enrollment –Chapter D – TPL –Chapter E – Buy-In/BENDEX –Chapter F – Client Medical Management & Managed Care –Chapter K – MMIS Member Letters Chapter G – Long-Term Care is scheduled to be released by May 15, The Appendix and Chapters H & I are now obsolete.

4 Department of Medical Assistance Services MMIS User Resources The Eligibility and Enrollment Unit of DMAS has begun preparing short Power Point presentations designed to assist workers with targeted issues. The first of these presentations has been posted to the Knowledge Center for access. Broadcasts will continue to be issued as these trainings become available. In the near future, links to these targeted presentations will be embedded into the MMIS User’s Guide to provide an alternate mechanism for learning appropriate enrollment procedures.

5 Department of Medical Assistance Services DMAS Classroom Training Poll The Eligibility and Enrollment Unit at DMAS is taking a poll to determine if local agencies would find it beneficial to have one representative from their agency to attend classroom trainings at DMAS. Topics will vary, but will include covering the MMIS User’s Guide in it’s entirety. Send your thoughts on this topic as well as topics for future trainings to the WebEx Inbox at

6 Department of Medical Assistance Services Provider Assistance Provider issues should be directed to the DMAS Provider Helpline at (800) (in state) or (804) (out of state). Providers with a Virginia Medicaid Provider ID should access the Medicall System or the Automated Response System (ARS). Telephone numbers for Medicall and access information can be found in Chapter A, page 10 of the MMIS User’s Guide.

7 Department of Medical Assistance Services MMIS Age Edit Entering the incorrect DOB for a member can result in the incorrect AC being assigned. The MMIS age edit will prevent workers from correcting the DOB when there is an ongoing AC that is not appropriate for the corrected age. These corrections must be prospectively when the member is assigned to an MCO.

8 Department of Medical Assistance Services MMIS Age Edit - Example Member DOB was incorrectly entered as 1/1/2010 and therefore was assigned to AC 090. Later, the worker discovers that the member’s correct DOB is 1/1/2005. When the worker attempts to update the member’s DOB the following age edit error message is returned by the MMIS: “Demographic Changes Invalidates Eligibility Rule” because in this example, the member is over the age of six, but is assigned to an AC for a member under the age of six.

9 Department of Medical Assistance Services MMIS Age Edit Example (continued)

10 Department of Medical Assistance Services MMIS Age Edit (continued) Take the following steps to correct the enrollment for these MCO members: –On the 18 th of the month, use cancel reason code 008 to cancel the member’s coverage on the day prior, the 17 th. (If the 18 th falls on a weekend, follow these steps on the Friday prior to the 18 th. ) –Correct the member’s date of birth and then re-enroll in the correct aid category effective on the 18 th of the month. –Send an to Carolyn Peete or Patti Davidson at DMAS requesting that the claims for this member be pended until the end of the month to prevent FFS from paying until the MCO benefit plan is reinstated for the

11 Department of Medical Assistance Services Member ID Numbers A member ID number is a permanent number that remains with the member, even when the case number is changed. The ONLY exception to this rule is when a member has a Social Security Number change. Notice: if this type of change occurs, the old and the number member ID numbers are NOT linked together.

12 Department of Medical Assistance Services Member ID Numbers (continued) If a case number is mistakenly entered into the MMIS as the member’s ID number, the numbers cannot be changed. Transposing the member’s case and member ID numbers will not effect the member’s eligibility or their enrollment in the MMIS.

13 Department of Medical Assistance Services Plan First – Pregnant Women M F.1 states that when eligibility in a pregnant woman covered group ends, prior to the cancellation of her coverage, determine if the woman meets the definition for another Medicaid covered group (see M ). If the woman does not meet the definition and/or the income requirements for another full-benefit covered group, determine her eligibility in the limited benefit Plan First covered group using the eligibility requirements in M

14 Department of Medical Assistance Services Plan First – Procedure When an enrollee between the ages of 19 and 64 no longer meets the requirements of their current coverage group, the LDSS should evaluate the member for Plan First coverage unless the individual is eligible for full-benefit Medicaid coverage, limited-benefit coverage as a Medicare beneficiary, or the individual declines Plan First coverage. If the member is under age 19 or over age 65, a Plan First evaluation is not required unless it is requested.

15 Department of Medical Assistance Services Plan First - Updates Plan First updates that were included in Broadcast 7291 and were effective 1/5/2012: –Plan First is not to be determined for children under 19 years of age unless the child’s parent requests an evaluation. –Individuals age 65 years and older should not be evaluated for Plan First coverage unless the individual requests an evaluation. –All individuals between the ages of 19 and 64 should continue to be evaluated unless the member chooses to opt out. This may be done verbally or in writing.

16 Department of Medical Assistance Services Smiles for Children Before 2005 Virginia’s Medicaid Dental Program had few providers (620 total providers statewide) and poor access, low reimbursement, multiple payers, and low utilization 2005-Present Realization that oral health and overall health tied together Collaboration among Medicaid, dentists, legislators, and others for change General Assembly supported a fee schedule increase of 30% All children are enrolled in one program administered by DentaQuest Streamlined credentialing and easy, industry-standard administration Dedicated provider service and customer outreach Ongoing provider involvement (Dental Advisor Committee) Dedicated call center for members Comprehensive benefits for members under 21 Limited emergency benefits for adults

17 Department of Medical Assistance Services SFC Utilization 2011

18 Department of Medical Assistance Services SFC Access 2011 In FY 2011, 45% of all eligible children actually received dental services Over 24% of Virginia dentists are participating The provider network has experienced an 153% increase since the program started Over 82% of participating providers are billing for services PARTCIPATING PROVIDERS

19 Department of Medical Assistance Services Smiles for Children (888) Find a dentist Get help making an appointment, if needed Answer questions about covered services Comprehensive dental care for members under 21 (preventive, restorative, orthodontics*) Limited emergency benefits for adults *Certain Criteria Apply

20 Department of Medical Assistance Services Medicaid Works The following new forms are now available which reflect the 2012 income levels for Medicaid Works: –Medicaid Works Fact Sheet –Medicaid Works Handbook –Medicaid Works Agreement (Contact the DMAS Medicaid Works Specialist to request forms.) Any questions or comments regarding the Medicaid Works program maybe directed to the Medicaid Works Specialist: Theresa Gonyo Phone: (804) Fax: (804)

21 Department of Medical Assistance Services Patient Pay Tips Changes in patient pay may only be made prospectively – never retroactively. See Medicaid Manual Chapter M for additional guidance. The LDSS should not delete patient pay segments without authorization from DMAS. The only circumstance that deletion of a patient pay segment would be appropriate is if an enrollee is discharged from LTC for a reason other than death and future patient pay segments are no longer valid OR when the enrollee dies prior to the begin date of the first patient pay segment.

22 Department of Medical Assistance Services Patient Pay Tips (continued) Per Broadcast 6931, workers should no longer use the “RCD” reason code to end date patient pay segments for deceased members. Using this code prevents entry of future patient pay segments, requiring MMIS fiscal agent involvement in cases where “RCD” is used in error. Until a change in programming associated with this reason code is implemented, workers should use reason code “OT” to end date the patient pay segment in which the date of death falls. This procedure is outlined in the broadcast as well as in Chapter G of the MMIS User’s Guide.

23 Department of Medical Assistance Services Patient Pay Tips (continued) If patient pay is zero and a CBC enrollee switches between different services, it is not necessary to change the provider. –Example: Member has zero patient pay and moves from personal care to respite care. The provider does not need to be changed in the MMIS; zero patient pay = zero patient pay. If a member enters the hospital and returns to the same LTC provider within the same month, a provider change is not necessary.

24 Department of Medical Assistance Services Patient Pay Tips (continued) In the event a patient pay segment has been mistakenly reduced, workers should send an to the patient pay inbox DMAS MMIS super users have limited ability to repair or restore these When a member leaves LTC the worker should end date the patient pay and delete future segments.

25 Department of Medical Assistance Services Patient Pay (continued) If it is discovered that there is a discrepancy with the member’s level of care send an along with the member’s ID number to Refer to Broadcast 5950 for procedures on handling information in patient pay reports and the identification of the reports.

26 Department of Medical Assistance Services Patient Pay Tips (continued) If the error message “Denied Access” is received when entering patient pay in the override function, there is an issue with the worker’s MMIS access. An should be sent to the Patient Pay Inbox along with the LDSS worker’s E-code to have the issue

27 Department of Medical Assistance Services Patient Pay Underpayments Workers are required to report certain patient pay underpayments as detailed in M D.3 and M of the Medicaid Eligibility Manual. Effective immediately, the thresholds for referrals to the DMAS Recipient Audit Unit for these underpayments will increase from $ to $1, to reduce the number of referrals workers must send to DMAS for recovery. See Broadcast 7373 for additional information. Questions regarding underpayment referrals may be directed to the DMAS Recipient Audit Unit at or by phone at (804)

28 Department of Medical Assistance Services Remember… Send all questions and proposed topics for future trainings to the or you may contact Sarah Samick, Lead Enrollment Phone: (804) Fax: (804) Refer to Broadcast 7378 for the 2012 DMAS WebEx training schedule. If you have viewed this part of the presentation through the Knowledge Center, don’t forget to join the DMAS Eligibility and Enrollment Unit for our live WebEx sessions.