1. Department of Medical Assistance Services
MMIS WebEx Training
Department of Medical Assistance Services – Eligibility and Enrollment Unit
October 2014
Welcome to the October 2014 MMIS WebEx training presented by the Eligibility and Enrollment Unit of the Department of Medical Assistance Services. 1

2. Agenda FIPS Codes Nursing Facilities and FIPS Codes
Hospital Presumptive Eligibility (HPE)
Aid Category (AC) 097
AC 099
MMIS Duplicate Process
Certain Newborns (NB’s) and Duplicate Linking
Pseudo Social Security Numbers (SSNs)
Hospitalized Newborns
Long-term care (LTC) and Exception Indicators
Cancel Reasons 350 & 360
TPL
Emergency Medical Certification (EMC) Inquiries
Health Insurance Premium Assistance Programs
Emergency Medical Certifications (EMC) Inquiries
Where to Send and Issue
In today’s presentation we will cover many topics to include the entry of FIPS codes, the duplicate process, newborn enrollment, pseudo social security numbers, HIPP, long-term care exception indicators, and TPL.

3. FIPS Codes
If address on Member Demographic screen is different than that on the Case Data screen the Member Demographics FIPS must be changed to match the address. This affects:
Foster Care Children
Commonwealth Coordinated Care (CCC) Enrollment
Managed Care Enrollment
Claims payment – different FIPS have different payment rates
Members who reside in a locality that is different from the locality where there case is maintained must have this information reflected in their address and FIPS codes. For example, a member’s case may be maintained in one county, but they may actually reside in a nursing facility that is in a completely different county. It is important that this information is accurate as it has an impact on which MCO the member is enrolled in, CCC passive enrollment, and even the payment rates for claims.

4. NF Facilities & FIPS Codes
Case FIPS code remains the FIPS code of the LDSS that maintains the eligibility.
Member Demographic FIPS code is the FIPS location of the facility in which the member resides.
Important – this affects Commonwealth Coordinated Care (CCC) enrollment
The case FIPS should reflect the FIPS code of the local agency that maintains the eligibility for the case. The member demographic screen FIPS should reflect the FIPS code for the locality in which the member actually resides. This is extremely important to remember for members who reside in nursing facilities as they could be passively enrolled into CCC, which is based on the FIPS code on the member demographic screen.

5. HPE Reminders LDSS agencies do not evaluate HPE eligibility
For coverage to continue beyond HPE period a full MA application must be submitted
If MA application is received the LDSS extends the HPE period in the MMIS if necessary
Instructions for entering HPE extensions can be found in Chapter C of the MMIS User’s Guide M
Hospital presumptive eligibility is never evaluated by local agencies. Continuing coverage is only evaluated by the local agency is a full MA application is received. If necessary, the HPE coverage can be extended in the MMIS in order to allow for the appropriate processing of the MA application. Chapter C of the MMIS User’s Guide contains instructions for extending HPE coverage.

6. AC 097 Only evaluate pregnant women as medically needy (MN) if:
Income exceeds 133% FPL
Income exceeds FAMIS Moms
If resources are within MN limit place on a spenddown (SD)
M A
If a pregnant woman is not eligible as 133% FPL because her income is too high, evaluate as FAMIS MOMS. If the individual is not eligible for FAMIS MOMS, then evaluate as MN. She may spenddown to the lower MN income limit IF her resources are within the MN resource limit. Enrollment into aid category 097 is appropriate only if this criteria is met.

7. AC 099
Only enroll newborns as MN AC 099 if they are born to a MN mother enrolled in AC 097.
Coverage in this AC ends at the end of the month in which the child reaches age one.
M A
A child who was born to a mother who is found eligible for Medicaid as medically needy or meets a spenddown effective on or before the date of the child’s birth would be enrolled in aid category 099 as medically needy newborn under the age of one. Coverage in this AC ends when the child reaches age one.

8. MMIS Duplicate Process
If possible duplicate is identified & LDSS does not believe the duplicate is the same person being added or changed a Duplicate Member Review request is submitted in the MMIS.
Instructions for submitting a duplicate member review can be found in Chapter C of the MMIS User’s Guide:
Instructions for submitting duplicate reviews to the Eligibility and Enrolment Unit of DMAS can be found in Chapter C of the MMIS User’s Guide. Duplicate reviews are only submitted when a possible duplicate is identified and the local agency does not believe that the person they are attempting to enroll is a duplicate.

9. MMIS Duplicate Process (cont.)
DMAS Enrollment Unit Staff will:
“A” – Approve the review; if not a duplicate
“D” – Deny the review; if a duplicate
Link the member ID numbers if it is a change/update transaction and the duplicate is the same person
DMAS will never approve a duplicate with matching SSN’s.
DMAS staff members regularly review the duplicate reviews submitted through the MMIS and approve or deny the request. DMAS will never approve a duplicate that has the same SSN! If an LDSS identifies a member who has been enrolled into the MMIS twice then a duplicate link request should be sent to the Elgibility and Enrollment Inbox so that staff members may link the duplicate ID’s together. If a duplicate review is requested for a member that has a similar name, exact date of birth and a pseudo SSN (such as twin newborns with almost exact names) it is recommended that the LDSS also send an to the Eligibility and Enrollment Inbox to advise staff members that the review has been requested and that the members are not duplicates to prevent DMAS staff from denying the request.

10. Certain NB’s & Duplicate Linking
Thorough file clearance of certain NB’s is necessary because:
DMAS adds some certain NB’s when their birth is reported by the MCO
They have pseudo SSN’s
They may be enrolled in MMIS, but not VaCMS
Remember to thoroughly file clear certain newborns before enrolling. Because DMAS staff members add some certain newborns as reported by the MCO the newborn could exist in the MMIS, but not in VaCMS. These members are harder to identify as they do not yet have social security numbers so a careful review of the mother’s case may be necessary.

11. Certain NB’s & Duplicate Linking (cont.)
If duplicate enrollment occurs in the MMIS:
the Enrollment Inbox to notify staff to link the two ID numbers
Be sure to close eligibility under associate (duplicate) ID
Note: Even if the duplicate eligibility is voided out with cancel reason “070” the duplicate ID numbers still need to be linked to prevent future use of the associate ID.
If a duplicate enrollment occurs submit an to the Eligibility and Enrollment Inbox requesting the two enrollments be linked together. This must be done even if the eligibility is voided out under the member ID number that is the duplicate. Linking the two ID numbers together deactivates the duplicate number and prevents it from being used in the future.

12. Psuedo SSN’s
Members who do not have a SSN must have a pseudo SSN entered
Only one format is acceptable for entry of pseudo numbers:
2 digit day of birth & 2 digit year of birth
999-MM-DDYY
All pseudos must begin with “999” 2 digit month of birth
Members who do not have a social security number such as aliens and newborns are entered into the MMIS with a pseudo number. There is only one acceptable format for entering pseudo social security numbers. All pseudo numbers must begin with “999” – all other prefixes are in use by the Social Security Administration which means they are sent up in the SSA match process. Use of prefixes other than “999” also results in another person’s real social security number being entered into the MMIS.

13. Hospitalized NB’s
NB’s in NICU for 30+ days & are eligible for LTC due to the exclusion of parent’s income:
These children must be reviewed to determine if the child will continue to be Medicaid eligible once the parent’s income is counted when discharged from the hospital
Check monthly to see if the child was discharged
Hospitalized newborns who are eligible for long-term care due to the exclusion of their parent’s income must be monitored on a regular basis. It is recommended that the local agency check on a monthly basis to see if the child has been discharged from the hospital. If a discharge has occurred the parent’s income would then be counted and a reevaluation of eligibility will be necessary.

14. LTC & Exception Indicators
Members who are enrolled in LTC:
Must have a LTC exception indicator on their benefit plan, if not:
LTC provider’s claim is not paid;
Member may not be eligible for Medicaid LTC services; and
Member could accumulate excess resources if patient pay is not being collected by the provider.
Member’s who are enrolled are approved for long-term care must have a long-term care exception indicator on their benefit plan. If the exception indicator is not on their benefit plan the member may not be eligible for long-term care services, the provider’s claims will not be paid and the member could accumulate excess resources if the patient pay is not being collected making the member ineligible. Local agencies cannot change a member’s benefit plan; refer any provider questions regarding the exception indicator or payment of claims to the DMAS Provider Helpline.

15. LTC & Exception Indicators
If no indicator present send an to the DMAS LTC Unit for research:
However, it is the provider’s responsibility to make sure they have the proper authorization to render services.
If local agency notices that a long-term care exception indicator is not on the member’s benefit plan an should be sent to the DMAS Long-term Care Unit at the address shown. The Long-term Care Unit will then research the issue and ensure that the exception indicator is entered if necessary. Ultimately, it is the provider’s responsibility to ensure that they have received the proper authorization to render long-term care services.

16. Cancel Reason 350 & 360 Created for VaCMS transactions:
350: Canceled and reinstated retroactively through VaCMS transaction
360: Canceled and reinstated prospectively through VaCMS transaction
Many have asked about the new “350” and “360” cancellation codes on the Eligibility screen. These cancellation codes were created for VaCMS transactions and reflect when coverage was cancelled and reinstated either retroactively or prospectively. We are currently working to have the MMIS tables updates to reflect these new cancellation codes and their meanings.

17. TPL
LDSS delete/retire policies instead of end dating them. TPL Unit has to re-enter them with the end date so claims during the policy period are cost avoided.
When sending s to TPL Unit to request insurance verifications and updates:
Provide the Medicaid ID# & DOB. 
Many times only the case number is given and then DMAS has to determine which member on the case have insurance and which ones need updates. This causes a delay for the LDSS and member.
Any request sent to the TPL Unit should include the member’s Medicaid ID number as well as their date of birth. Member specific information cannot be determined by case numbers alone and sending these numbers results in a delay of the request being processed.

18. HIPP
Working families with employer based insurance may be eligible for assistance of premium payments
HIPP information & application available in the Client Services section of the DMAS webpage:
LDSS workers can questions to HIPP at:
Public can questions to HIPP at:
Families who have employer based insurance may be eligible for assistance of their premium payments through the HIPP program. There are many resources for obtaining information regarding the HIPP program to include the DMAS webpage and/or by sending an directly to the HIPP Unit through either the LDSS HIPP Inbox or the Public HIPP Inbox.

19. MMIS Coverage Correction Form
New Form (dmas eng) is now available in the Forms section of the SPARK page that will help streamline submissions.
Includes:
a section for requesting duplicate member ID linking as well as requests for resetting a member’s ID indicator.
Eliminates:
MMIS Duplicate Member ID Link Request form ( eng); and
MMIS Reset ID Card Indicator Request form (form number eng ).
A new MMIS Coverage Correction form has been created to help streamline submissions to the Enrollment Inbox. The creation of this new form will eliminate the use of the Duplicate Member ID Link Request form as well as the MMIS Reset ID Card Indicator Request form. New sections have been added to the Coverage Correction form for these two types of requests. It is expected that this new form will be posted to the SPARK page in the near future for use. A broadcast and portal announcement will be released announcing the availability of the form.

20. Email: Jamene.cox@dmas.virginia.gov
EMC Inquiries
Information regarding outstanding EMC’s can be obtained from:
Jamene Cox, DMAS
Phone: (804)
Questions regarding Emergency Medical Certifications that have been submitted to DMAS may be directed to Jamene Cox of the Payment Processing Unit by either the or phone number shown.

21. Where to send an issue…
Send questions and comments about training or ideas for future training to:
Eligibility and Enrollment issues should be sent to the Enrollment Inbox at
Patient Pay enrollment questions or issues should be sent to the Patient Pay Inbox at
Issues regarding coverage correction in the MMIS, patient pay in the MMIS or future training ideas or questions can be sent to one of the Eligibility and Enrollment Unit Inboxes shown.

22. Help is an away…
BUY IN UNIT Assistance with state Buy-In: (804) (804) HIPP UNIT Assistance for LDSS with HIPP issues: (800) LTC UNIT Assistance with level of care issues & related PP reports, admit dates: (804) TPL UNIT Assistance with TPL issues including carrier codes (804) MANAGED CARE HELPLINE Assistance for members (800) MEMBER HELPLINE: (804)
On the DMAS website there is a wealth of information for members; it is a great resource for workers as well. Additionally, most units that assist local agencies have an inbox that can be used for sending questions or issues.

23. Continued…
Lois Brengel, Program Manager Eligibility & Enrollment Unit (804) Sarah Samick, Enrollment Supervisor (804) Cindy Olson, Policy Manager Policy Unit (804) Tiaa Lewis, HIPP Buy-in Supervisor HIPP & Buy-in Unit (804)
If assistance is needed with a matter that is not appropriate for one of the inboxes, individuals within the Eligibility and Enrollment, HIPP and Buy-in, and Policy Units can be reached by phone or as shown.

24. Thank you…
Thank you for viewing this presentation. Continue to send questions and comments about this training or ideas for future trainings to: Eligibility and Enrollment issues should be sent to the Enrollment Inbox at Patient Pay enrollment questions or issues should be sent to the Patient Pay Inbox at
Thank you for viewing today’s presentation. Please continue to send ideas for future WebEx trainings to the MMIS WebEx Inbox shown. Issues regarding eligibility and enrollment or patient pay in the MMIS should be send to the appropriate addresses on this slide. The next MMIS WebEx schedule for 2015 should be expected in January 2015 by broadcast as well as in the announcements section of the MMIS portal.

25. Thank You for All you do!!!!!