Transcript IL IT Refresher Training - Illinois Mental Health Collaborative for

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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
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DMH Introduction
Presenter: Mary E. Smith, Ph.D.
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Purpose of Training
◦ Refresher/Review of Key Processes
◦ Availability of Resources and Tools
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Registration Design
◦ Data Elements
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Use of Registration Data
◦ Decision Support and Planning
◦ Federal Reporting
◦ Ability to look at change across time
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Timely Submission of Registrations
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Presenter: Terry Schoonover
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Recipient Eligibility File
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Williams Class Consumer Eligibility File
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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)
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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)
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Presenter: Terry Schoonover
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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
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Consumer Registration
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OBRA Codes (reimbursement rate for ABC fund)
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Clinical Authorization
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Provider Site Fund Codes (funds in which a site
is contracted)
MARS File (claims data from HFS)
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VO processes registration and assigns funds
VO sends fund information to HFS within 1
business day
Registration file
VO
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HFS
HFS processes file (accepts or rejects) and
sends results to VO by the 2nd business day
VO
Registration Response file
HFS
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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
OBRA file
VO
HFS
◦ HFS processes file (accepts or rejects) and sends
results to VO by the 2nd business day
VO
OBRA Response file
HFS
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VO processes the authorization request
VO sends the approved authorizations to HFS
within 1 business day.
Clinical Auth file
VO
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HFS
HFS processes file (accepts or rejects) and
sends results to VO by the 2nd business day
VO
Clinical Auth Response file
HFS
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These are funds that a site has available to use
for claims reimbursement (ABC, 821, etc.).
DMH sends site fund code changes to VO.
Site Fund Changes
VO
DMH
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VO updates the record in the VO system.
VO then forwards the change to HFS, so the
HFS system can be updated as well.
VO
Forwarding Site Fund Changes
HFS
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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
MARS file (processed claim data)
HFS
VO
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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
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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) 247-9311, Monday
through Friday, 7am to 5pm CDT
◦ The turn-around time for additional logons is 48 hours
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www.illinoismentalhealthcollaborative.com/provider/prv_information.htm, under the
Registration Title, sub titled ProviderConnect Registration Guide (December 2011)
•The
registration Process is used to determine a consumers eligibility
•Obtain
•In
a RIN and DHS Social Services (DHS SS) for the consumer through E-Rin System
the Collaborative system Programs are labeled as Funds
•Please
read or reread the guides located at:
http://www.illinoismentalhealthcollaborative.com/provider/prv_information.htm
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Red Dot Error Example
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Successful Submission Confirmation Example:
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Live Demo
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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 …..
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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:
 http://www.illinoismentalhealthcollaborative.com/provider/prv_
information.htm
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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
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Please Note: Refer to the Batch Registration Submission Guide for detailed information
regarding error messages and error file naming conventions.
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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.
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Please Note: Refer to the Batch Registration Submission Guide for detailed information
regarding response file content, naming conventions, and file layouts.
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Presenter: Terry Schoonover
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After a consumer is registered, the funds can
be viewed
◦ Start from ProviderConnect Home as seen below
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Enter Consumer ID (RIN) and Date of Birth
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On the Demographic page, click “View
Consumer Registrations”
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Funds are listed with date range
◦ To find the ABC benefit package assigned, click the
“ILAS” link that corresponds to the ABC fund
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There are 3 categories of ABC benefit
packages that can pay claims (1st Presentation,
Target, or Eligible)
◦ The First Presentation Indicator and Eligibility Status
fields will identify the ABC benefit package that is
assigned
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Eligibility Status &
1st Presentation Indicator
shown in ProviderConnect
1st Presentation Indicated
‘Yes’
Eligibility Status is TADL and
1st Presentation is ‘No’
Eligibility Status is TCHD and
1st Presentation is ‘No’
Eligibility Status is ELIG and
1st Presentation is ‘No’
Benefit Package
Assigned
ABC – 1st SMI
ABC – Target
Adult
ABC – Target
Child
ABC – Eligible
Clarification
If 1st Presentation Indicator is ‘Yes’, regardless of Eligibility Status, the
“1st SMI” benefit package is assigned. It covers a larger range of
services than an “Eligible” benefit package.
(as shown on DMH Service Matrix)
Being that 1st Presentation Indicator is ‘No’, the “Target Adult” benefit
package is assigned. A Target benefit package currently covers the
same services as 1st SMI. Again, this covers a larger range of services
than an Eligible benefit package.
(as shown on DMH Service Matrix)
Being that 1st Presentation Indicator is ‘No’, the “Target Child” benefit
package is assigned. A Target benefit package currently covers the
same services as 1st SMI. Again, this covers a larger range of services
than an Eligible benefit package.
(as shown on DMH Service Matrix)
Being that 1st Presentation Indicator is ‘No’, the “Eligible” benefit
package is assigned. An Eligible benefit package covers a smaller
number of services than a 1st Presentation or Target benefit package.
(as shown on DMH Service Matrix)
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Presenter: Terry Schoonover
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This guide is posted to the “In the Spotlight…” section of the Collaborative
website at http://www.illinoismentalhealthcollaborative.com
Reason For Call
Claims/Billing Issues before or after 7/1/11
HFS Claims Transition
Service Authorization
For a provider to pre-authorize care
Inquire about an existing authorization
Registration questions
(technical or nontechnical in nature)
Technical difficulty with the Collaborative
system such as:
Account disabled
System “freezing” or crashing
System unavailable errors
Utilization Management (Clinical)
IntelligenceConnect Reporting Issues
No RIN or Social Service Package B Issues
Multiple RIN Issues
DMH Policy Issues
Contact Number To Use
HFS Bureau of Comprehensive Health Services
877-782-5565, Press “0”; ask for a Community
Mental Health Support Consultant
HFS EDI Help Desk: 217-524-3814
The Collaborative (866) 359-7953, select the
provider menu, then press 1.
EDI Help Desk (888) 247-9311
The Collaborative (866) 359-7953, select the
provider menu, then press 1.
EDI Help Desk (888) 247-9311
DHS/Customer Support:
Jay Hidalgo (800) 385-0872
The Collaborative (866) 359-7953, select the
provider menu, then press 1.
DMH Regional Staff
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Call the Collaborative at (866) 359-7953, 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
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