1. World Wide Tour: Bridging the Gap Between VaCMS and MMIS
Jessica Annecchini, MA Consultant, VDSS
Ruth Mulkey, Supervisor, Enrollment Unit, DMAS

2. Agenda VaCMS  VaCMS Screens: VaCMS/MMIS Failures Client Demographics
Alien
Third Party Resources
Certification Period Override
MMIS Individual Details
MMIS Transaction History
Match MMIS Case/Enrollee IDs in VaCMS
This presentation will be in two sections; VaCMS and MMIS. We will be giving a high level overview of both systems to allow as much time as possible to answer your questions to ensure local agencies can make corrections to enroll through VaCMS without the need for coverage corrections.
How to Read Failures
How to Resend Transactions
When to Send a Ticket
Running RCR

3. Acronyms AC – Aid Category
EDBC – Eligibility Determination Benefit Calculation
EDG – Eligibility Determination Group
MMIS – Medicaid Management Information System
NB – Newborn
NPI – National Provider Identifier
QRG – Quick Reference Guide
RCR – Retro Cancel Reinstate
TPL – Third Party Liability
VaCMS – Virginia Case Management System

4. VaCMS Screens Client Demographics Alien
Citizenship Verified Through Deemed NB
NPI
Type of Medical Assistance Mother Received or Expected to Receive at the Time of Child Birth
Alien
Verification Source
Alien Category
Foreign Passport Country of Issuance
Emergency/Restricted Coverage Dates
If Mother ID is required and it’s not a deemed NB, look here
NPI was an old error around Nov 2018 but if it occurs update effective date and MCO date
This is the question you must answer to get the deemed NB result; the PG woman does not have to be on the same case
If you used SAVE outside of VaCMS or VPL within, use the system verifications
The country is very important when populating to VaCMS; if there is a known enrollee ID, be sure to match the information you have on file, or if they became a citizen, update this in MMIS
Alien Category – this can make a difference for emergency services
Emergency/Restricted Coverage Dates – always enter as pend until approved

5. VaCMS Screens Third Party Resources Certification Period Override
Carrier Code
Policy #
Ending Policies
Certification Period Override
If not updated by system can use this feature
Must know EDG# and Case#
Carrier Code – if error occurs use lookup
Policy # - Remember Medicare recipients have new beneficiary numbers, and some you can find in MMIS if they existed previously
Ending policies – you do have to have verification still and make sure you end on both effective date and policy details
Certification period override does send an update to MMIS

6. VaCMS Screens MMIS Individual Details MMIS Transaction History
The only place to make a new enrollee ID and case number for local agency
Updates relationship
The ability to assign a new enrollee ID is only available the first time a case is authorized
MMIS Transaction History
Shows failures
Shows who authorized the case in some case actions
Where you resend failures
If an incorrect case/id is made then you use the match mmis case/enrollee id screen to match and resend
You can assign a case ID in other case actions now.
Relationship is to case head in VaCMS but you can fix this in MMIS and it will update
Use the MMIS transaction history screen in combination with the notices to see who authorized a case

7. VaCMS Screens Match MMIS Case/Enrollee IDs in VaCMS
After individuals are authorized, this is the screen you can use to fix certain failures
This screen does a point in time match with MMIS if information is changed to ensure it matches
If you have to move someone from one MMIS to another, you will have to go in MMIS first, then come to this screen
This screen is also helpful once a new enrollee ID and case is assigned outside of VaCMS if that is the only way to fix the issue.
You are able to pull individuals from one case to another in MMIS provided the case numbers exist, so if it didn’t match them correctly in VaCMS the first time you are able to do so manually and the update the information on this screen.

8. VaCMS/MMIS Failures How to Read Failures Top Failure Reasons
Hover over failure code and text will appear
Selecting the Resend button will give more information on fix
Top Failure Reasons
Before authorization:
Mother ID
Language
NPI
After Authorization:
Valid Case/Enrollee ID
TPL failures
Possible Duplicates
As we talked about before Mother ID is usually an issue on the client demographics.
Language is on the client screen.
NPI is also on client demographics.
You may also get messages about TPL or carrier codes, these are on the Third Party Resources screen.
Some of the issues that come up after authorization require you to go into VaCMS as a case change/closure to update the information like some of the TPL failures (Medicare claim numbers have changed to be sure to check MMIS before putting the information in VaCMS if the person existed before)
The valid case/id or duplicate issues will need to be fixed in MMIS and then use the match MMIS/VaCMS screen to align for future transactions.

9. VaCMS/MMIS Failures How to Resend Failures When to Submit a Ticket
Click resend link
Read fix suggestions and use VaCMS and MMIS to fix issue
May have to navigate to Match MMIS Screen first
Always to go MMIS Individual Details to finish the resend
When to Submit a Ticket
When the resend does not complete
If the Match MMIS or MMIS Individuals screen do not update successfully
If the failure that is before authorization cannot be cleared
After clicking resend you may get additional information in order to fix the failure, also use MMIS help to get issue explanation.
If you do not go to the MMIS individual details screen and click next to finish the resend your transactions will remain as resend-pending. This could interfere with future transactions.
Basically tickets are required if you couldn’t use resend to complete your issue (other than duplicates) or you cannot match VaCMS and MMIS after the enrollment has been completed.
If you are not able to authorize the case you must submit a ticket but you do not have to wait for ticket resolution to have the individual enrolled.
Submit tickets on the valid case/id errors even though they will be enrolled in MMIS and then you will use the match MMIS/VaCMS links but you can use the information VaCMS case for case and id on your coverage correction form as long as it does not belong to someone else.

10. VaCMS/MMIS - RCR Running RCR
Eligibility must be on current case and can only run up to 12 months in the past
Can be used for things like closure 12 in MMIS, gaps in coverage, and some failed transactions
Can only be performed in Case Change/Closure Case Action
On the Wrap Up - Run Eligibility Screen, enter a date in the “Run EDBC From” field
Changes that result in a change in AC will be reflected in Eligibility Summary; changes that do not result in AC change or are higher to lower coverage, show authorization as “No Action Needed”
If resending a transaction you will have to complete an override and re-run eligibility exactly the same way
Now sometimes you don’t see a failure, sometimes the transaction just does not go through, or someone calls you later and you see it was a closure 012.
This is where we use RCR. If you have been around in the times where you could update MMIS, RCR was used to go back in time and give coverage to someone. There is a way to reflect this in VaCMS and also to force a reinstate transaction.
RCR recalculates Patient Pay and if a SD is present, RCR will always run back to the first month of the SD regardless of the Run EDBC From date entered

11. VaCMS/MMIS - RCR
As we discussed you have to put in the month you want to run EDBC from; an end date is not necessary; it will run for all HH members so you need to be sure to look at all individuals results to make sure no one else is changing.
If you see other changes you may need to review the income and HH comp to see if effective dates need to be updated.
When working a change you should be using this even if it is a negative to change to reflect you have reviewed the change back to it’s effective date and if you need to make a RAU referral.

12. VaCMS/MMIS Failures
Service period should be the first month you want the coverage to start.
Override begin date is the first day you want the coverage to start; end date is optional, it depends if there is a gap in coverage.
You must select the Reinstate Eligibility for Past Months box, this is what tells VaCMS to actually create the reinstate transaction.
Override reason must detail why you are resending the transaction.
There should be no reason to update the other fields.
You have to re-run eligibility in order for the Override to be applied!

13. Resources QRGs: Reinstating a Program Retro Cancel Reinstate
Changing a MA Renewal Date
Preventing Common MMIS Transaction Failures
MMIS Transactions - Resending
Reinstating a Program goes through the correct steps to complete grace period renewals.
Retro Cancel Reinstate goes over the steps we just discussed but remember you have to re-run eligibility after completing the override.

14. Questions

15. Contact Information:

16. BPRO Spring Conference Roanoke, VA May 29 – 31, 2019
World Wide Tour: Bridging the Gap Between VaCMS and MMIS Navigating in MMIS - Member Management Information System
Navigating in MMIS as a worker is a great tool to determine if a member is currently known to MMIS;
The UPDATED INFORMATION MMIS Bridge Closure – Phase 3 Broadcast dated 2/20/2018, emphasized that effective 4/1/2018 local agency designees no longer had access to add or reinstate eligibility or make aid category changes directly in MMIS.
BPRO Spring Conference
Roanoke, VA
May 29 – 31, 2019

17. What Can A Worker Do in MMIS?
Edit/update Member and Case Information
Member/Case Demographics Screen
Citizenship, Identity, SSN, Address
Move a Member from one case to another
Conduct Inquiries
Help Feature
Effective 4/1/2018 LDSS workers were allowed
Ability to edit/update Case and Member Demographic information (i.e., address, SSN, DOB, Citizenship, and Identity, VaCMS client/case information as well as worker number);
Conduct MMIS Inquiries on both Member and Case;
“Help” feature is available to navigate through the MMIS application.

18. MEMBER DEMOGRAPHICS – INQUIRY
Member Demographics - Inquiries can be performed to view Member and Case information. Individuals known to MMIS are identified by a unique Member/Enrollee ID#. Searches can also be performed by entering the full name, SSN and gender.

19. ELIGIBILITY DATA - INQUIRY
The Eligibility Data Inquiry screen allows the worker to view the member’s eligibility/enrollment to determine the Aid category; the Begin/End date; and, the status of the line of coverage (i.e., A – active, C-closed, and V-void). Further inquiry can be viewed by selecting the radio button to view the Benefit Plan and Plan Description along with Provider information. This is how the worker can see if the Level of Care for LTC is entered. While the worker cannot update this information, as long as the information is present the provider needs to call the provider helpline to get assistance in receiving payment. A list of Cancel Reasons is located under MA Training on FUSION.

20. SCREEN HELP SCREEN HELP
All too often, workers attempt to determine what values should be used when entering Member information and will contact the Enrollment Unit for assistance.
Selecting the “Help” feature will provide guidance. Additionally, each page Help feature that is specific to the given page.

21. SCREEN HELP
Once the “help” feature is selected, assistance interpreting the information listed on all screens is available by clicking the hyperlink.

22. SCREEN HELP – Hyperlink Level
Selecting the
hyperlink
for the field provides
details of the data listed
Selecting the hyperlink for the field provides details of the data listed.

23. CITIZENSHIP STATUS CITIZENSHIP STATUS
Selecting the “help” feature can assist with determining which citizenship status should be used.

24. Citizenship Status CITIZENSHIP STATUS –
The citizenship status is transmitted through VaCMS case processing. There are times when this information may need to be updated directly in MMIS. For example, changing an individual from undocumented/illegal alien or legal Alien eligible only for emergency services - Alien (A) status to Dialysis (D) status as undocumented/illegal alien or legal alien eligible only for dialysis services. In this instance, the worker should make the correction and can utilize the Help screen feature to facilitate the change when necessary.

25. CITIZENSHIP LEVEL

26. Citizenship Levels
FH – Federal Hub
Level 1

27. IDENTITY

28. Identity

29. MMIS Coverage Correction Request Form
Coverage Change Requested
Indicate the missing coverage needed to be entered
FPL STATUS
Income < 100 % FPL
“Y” or “N”
Selecting “Y” or “N” impacts Member co-pays and deductibles as well as claims and fees
Reference the Medicaid: 2019 Federal Poverty Level (FPL) Income Broadcast dated 1/30/2019 – VDSS Intranet
Reference the HHS Poverty Income Limits to Specified Percentages and Medically Needy Income Limits – VDSS Intranet
Jessica’s note: there is also a demographic appendix under forms used when a new case/enrollee ID needs to be created

30. DMAS Enrollment Unit BROADCAST dated 3/26/2019
Corrective Information Related to MMIS Enrollment
Enrollment Unit staff has been diverted to process the following requests:
• Urgent MMIS Coverage Corrections that can't be handled by the Regional Consultant; • Same Day Voids; • Enrollment of pregnant women that can't be handled by the Regional Consultant; • Patient pay corrections
A Broadcast was released on 3/26/2019 entitled, “Corrective Information Related to MMIS Enrollment”. This broadcast outlined how MMIS Coverage Corrections were being managed during a temporary change in processing. This project has ended and the Enrollment Unit is currently processing requests.
The Enrollment Unit will continue to process the following requests;
Urgent/High Priority
Patient Pay Correction Requests;
Same Day Voids;
Enrollment of pregnant women that can’t be handled by the Regional Consultant;
Spend down enrollments;
Duplicate member linking (send Duplicate check electronically and MMIS Correction Request form).
When submitting requests:
Urgent/High Priority requests must have the word “urgent” noted in subject line;
Same Day Void requests must have the words in the subject line
Pharmacy/medication issues – “Urgent” in subject line
Breast/cervical cancer issues - “Urgent” in subject line
Members unable to secure services (hospital, doctor’s office) - “Urgent” in subject line

31. Where to Send Forms? Coverage Correction Forms
Patient Pay Correction Forms
TPL Questions
Buy-In Questions
Enrollment Unit Mailbox: submit completed MMIS Coverage Correction Request Forms only
Patient Pay Unit Mailbox: submit Patient Pay Request Forms only
TPL Unit Mailbox: Questions regarding Third Party Liability (TPL) only
Buy-In Unit Mailbox: coordinator for assistance with State Buy-In questions and premium payments; Medicare updates or inputs; erroneous death cancellations

32. Supervisor, Enrollment Unit
Thank you!
Ruth Mulkey
Supervisor, Enrollment Unit
(804)