1. BPRO Medicaid ag committee meeting
Friday, May 17, 2019
The DMAS Enrollment Unit reports to the Eligibility and Enrollment Services Division of the Department of Medical Assistance Services under the leadership of Cindy Olson, Division Director. We are located at 600 East Broad Street, Downtown Richmond.

2. What Does the DMAS Enrollment Unit Do?
Ensure member enrollment accuracy
Conduct Inquiries to make corrections
Add coverage
Adjust Aid Categories
Edit/update Member and Case Information in MMIS
Reports
The Enrollment Unit makes edits and/or corrections to member and cases with effective beginning and ending dates as well as ensure the appropriate Aid Category is being utilized.
Monthly reports received from our Data Analytics department must be processed in an effort to correct member enrollment information;
Some of the reports include RSO This report is the SSN Discrepancy report and must be in compliance with CMS.

3. MEMBER DEMOGRAPHICS – Updates
Member Demographics – Updates can be performed to Member and Case information by the LDSS worker. 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.

4. 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). Further inquiry can be viewed by selecting the radio button to view the Benefit Plan and Plan Description along with Provider information.
Due to bridge closure, workers are unable to modify enrollment data at this time.

5. REPORTS

6. MA Application - SSN Requirements
MA Policy M B
A social security number verified by the Social Security Administration is necessary accurate Medicaid application evaluation
Medicaid Policy M B indicates that a valid social security number verified by the Social Security Administration is necessary for the accurate evaluation of a Medicaid application.

7. Citizenship & Identity Procedures
M D
During the eligibility determination process through VaCMS, the social security data match takes place when the individual’s information is sent through the HUB.

8. MMIS Data Matches SSA
Cases not processed in VaCMS, the SSA data match will take place after the individual has been enrolled in MMIS.
If the information in the MMIS matches the information contained in the SSA files, the MMIS will be updated to reflect the verification of C&I.
No further action is needed on the part of the eligibility worker, and the enrollee will not be required to provide any additional documentation, if the SSA match code in MMIS shows that SSA verified the individual’s C&I. M
Cases not processed in VaCMS, the SSA data match will take place after the individual has been enrolled in MMIS.
If the information in the MMIS matches the information contained in the SSA files, the MMIS will be updated to reflect the verification of C&I.
No further action is needed on the part of the eligibility worker, and the enrollee will not be required to provide any additional documentation, if the SSA match code in MMIS shows that SSA verified the individual’s C&I.

9. MMIS Data Does Not Match SSA
If the information in the MMIS does not match the information in the SSA files, a discrepancy report generates monthly listing the inconsistent information. Eligibility staff is expected to review the report to see if the report lists any enrollees who were rejected because SSA could not verify the enrollee’s citizenship and identity.

10. RSO 485 Discrepancy Reports
Generated monthly
Sent to Regional Consultants by FIPS
Sent to the LDSS staff
LDSS Staff makes corrections in VaCMS and MMIS
LDSS gives the RC results
Regional Consultant notifies EU Supervisor

11. Duplicate Member
Medicaid Policy

12. Duplicate Enrollee/Member
LDSS staff initiate the duplicate member enrollment process either through VaCMS or MMIS;
Twice daily, the Enrollment Unit staff reviews and monitors the duplicate review process in the override screen of MMIS.

13. If a possible duplicate is identified in the LDSS worker believes that the possible duplicate is not their member, then a DMAS duplicate review should be requested by taking the following steps:
Log into MMIS
From the Enrollment Menu enter the member ID# that received the possible duplicate error message and click “duplicate member”;
In the duplicate member review inquiry screen enter “Y” in the “Req Review Y/N” box;
Press enter and update.

14. New Member Data Section
The information on the top half of the page is the new information the LDSS is attempting to add or change;
Possible Duplicates Section
The information on the bottom half of the page is the existing enrollment. The information is compared by Enrollment Unit staff to determine if the members are duplicates or not.
Duplicate match criteria includes SSN; Full/partial name; DOB
TDO members; assessments; Newborns are generally already in MMIS with a 975# and that number is the member’s enrollee ID# and should be used in VaCMS for processing.

15. When both member ID#s have active enrollment, a determination must be made by the LDSS as to which ID# should be used. The active member ID# will be the permanent ID# and the cancelled member ID# eill become the associate ID#.
A MMIS Coverage Correction Request Form should be submitted to mailbox to identify which is the permanent and the associate ID#s.

16. MMIS Coverage Correction Request Form
Duplicate Member ID Link Section provides the LDSS worker the opportunity to identify which member ID# is permanent and which becomes the associate.
This form should be sent via to

17. PATIENT PAY
Patient Pay

18. Patient pay corrections are managed by the DMAS Enrollment Unit by submitting completed Patient Pay Request Forms to

19. PATIENT PAY Patient Pay cannot be increased in the past
Patient Pay does not apply to Medicaid expansion
Medicaid Policy M – Patient Pay Information
After an individual in long-term care is found eligible for Medicaid, the recipient’s patient pay must be determined. When the patient pay amount is initially established or when it is changed, the worker enters the information in VaCMS. VaCMS sends the “Notice of Obligation for Long-Term Care Costs” to the enrollee or the enrollee’s authorized representative.
When patient pay increases, the “Notice of Obligation for Long-Term Care Costs” is sent in advance of the date the new amount is effective.
Patient Pay cannot be increased in the past
Patient Pay does not apply to Medicaid Expansion

20. Where to Send Forms? Enrollment Unit Patient Pay Unit
Patient Pay Unit
Enrollment Unit Mailbox: submit completed MMIS Coverage Correction Request Forms only
Patient Pay Unit Mailbox: submit Patient Pay Request Forms only