Transcript Provider Relations - Illinois Mental Health Collaborative

Illinois Department of Human Services /
Division of Mental Health
and
Illinois Mental Health Collaborative
Present
Introduction To IntelligenceConnect and
Reporting
December 2008
Agenda



Introductions
Access IntelligenceConnect
Claims Reports
–
–



2
Review Available Reports/Data Set
Review Upcoming Reports
Questions
Review Upcoming Registration Reports
Questions
Introductions
Kathy Melia, Collaborative VP Operations
Lisa Laplante, Collaborative Claims Director
Cathy Doran, Collaborative EDI Help Desk Manager
Karen Vendetti, Collaborative Eligibility Director
Mike Wagner, Collaborative Claims Manager
Jason Martin, Collaborative Reporting Analyst
3
Reports and Data Sets

HFS Eligibility data and Claims data is downloaded to the
warehouse on a weekly basis:
–

Registration data is updated daily and includes data submitted
the previous day
–



4
Updated information becomes available on Mondays and includes
data submitted through the previous Friday by 6pm
Online and Batch
Only registrations entered into the Collaborative’s system are
available for reporting
Reports are delivered in a “PDF” format (Portable Document
Format)
Data sets are created in the Microsoft Excel format and can be
downloaded to a local desktop for analysis and ad-hoc
reporting
Overview: IntelligenceConnect
IntelligenceConnect provides a method for providers or their designated
representatives to generate reports regarding claims or registrations for
Illinois consumers.
– Access IntelligenceConnect via link from ProviderConnect
– Enter data into a series of screens or windows with drop down
boxes or fields to set report parameters
– All data comes from Collaborative’s Data Warehouse
Claims, HFS Eligibility and Registration data used for these reports
is entered into, or generated by, the adjudication processes from the
various Collaborative systems and then downloaded into our data
warehouse.
5
Claim Reports
Excel Data Set
Includes all claims detail for finalized claims
EDI 837P Management Reports – in pdf format
Monitor claim volumes and staff productivity by submission date,
submitter ID, or submission #
Claim Status – in pdf format
Monitor claim results by those paid, denied and still in process
6
Access Claims Reports
Log-on ProviderConnect via the Illinois
Mental Health Collaborative Website
www.illinoismentalhealthcollaborative.com

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837P and/or DCS
Denied Claim Lines by Submission Date
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
Shows denied claim lines for a date range, regardless of the
manner of claim submission (batch or direct)

Report shows claim line detail of those claims finalized to deny
including primary reason for denial

EOP message shown is the message received on Provider
Summary Voucher. More generic HIPAA compliant description
on 835
Claims Reports
Report Name
Description of Report
Parameters for entry
Fields Generated
ILL Report of Denied
Claim Lines by
Submission Date
A detailed pdf report
Submission Start Date
Submission End Date
Batch Submission #
Provider (All "*" or
Specific)
Claim #, Line, RIN,
Provider #, Service Date,
Service Code, Claim
Amt., Denial Code, EOP
Denial Description, Line
Item Control #, Submitted
Program Code, Staff ID,
Place of Service, Service
Location, NPI #,
Consumer Name
ILL Report of Denied
Claim Lines by
Submission Date – Fund
Source
ILL Report of Denied
Claim Lines by
Submission Date –
Consumer Name
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23
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Report of Staff ID Activity Submitted by Service Date
At each service location a summary of total
services provided by each staff member,
including total units and charges on a
specified service date
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Claims Reports
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Report Name
Description of Report
Parameters for entry
Fields Generated
ILL Report of Staff ID
Activity Submitted by
Service Date
A Summary pdf report
Submission Start Date
Submission End Date
Staff ID (All "*" or
Specific)
Provider (All "*" or
Specific)
Service Location
Submitter ID
Staff ID
Place of Service Code
Service Code
Units
Claim Amt.
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Report of Staff ID Activity Submitted by Service Date-Sample
Report
ILL Report of Staff ID Activity Submitted by Service Date
Submitter ID
123456
Service Start Date
Staff ID
POS Code
Date of Service
Charges
Service Location : XYZ Street
11
09/15/08
Service End Date
Service & Modifiers
09/16/08
Total Units
Total
000000005
9/15/2008
H0032
HO
H0004
H0004
H0032
HO
HQ
HO
H0004
H0032
H2015
HO
HO
HO
H2017
T1016
HQ
TG
H2017
HQ
200
10
00
$ 1,685.25
$ 200.00
.00
8
$ 144.16
16
16
4
$ 288.32
$ 96.16
$ 72.08
10
4
9
$180.20
$ 72.08
$162.18
HO
HN
70
1
$ 420.70
$ 16.65
HO
72
$ 432.72
9/16/2008
HO
000000008
9/16/2008
000000010
9/15/2008
9/16/2008
Service Location
XYZ Street
43
Approved Units, Charges
Denied Units, Charges
In Process Units, Charges
Excel Data Set
Claim Detail –Excel format data set of finalized claims that can be saved
to Provider’s desktop and sorted according to provider’s preference.
Select by either received (submission) date, service date, or paid date. A
specific date or date range is required to limit data set size.
Additional selection criteria:

A specific consumer or all consumers,

A specific service code or all service codes


44
Data Set is limited by Excel’s limitations.
Providers need to plan timing and approach to extracting data
Claim Data Set
45
Data Set
Description of Data Set
Parameters for entry
ILL Claims Detail Data Set
A detailed Excel data set for claims
that have been finalized through
posting
Provider (All "*" or Specific)
Beginning Received/Service/Paid
Date
Ending Received/Service/Paid
Date
Consumer #
Service Code
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Data Set
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Claim #
Claim number assigned by the Collaborative
Vendor #
Collaborative assigned identification for provider service location
RIN
Consumer ID #
Line #
the line number within the claim
DOS
Date of Service
Service Code
HCPCS or CPT code
Mod 1,Mod 2,Mod 3, Mod 4
Up to 4 modifiers as submitted by provider
Dx Code 1,Dx Code 2,Dx Code 3
Up to 3 diagnosis codes, as submitted by provider
Charge
the Billed amount for this service code
Allowed
The fee schedule allowed amount
Prepaid Amt
The amount approved to apply against pre-payment amount
Paid Amt
If dollars are paid, the amount paid here
Paid Date
The date the claim went through a payment cycle
Remark Code 1, Remark Code 2, Remark
Code 3, Remark Code 4
The messages that will appear on Provider Voucher to explain a denial
Line Item Control #
Optional control number submitted by provider
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Patient Account#
Optional patient identifier as submitted by provider
Activity Code
The W code that accompanied service code S9986 in the line note
Duration
Length of time the session lasted as submitted by provider in line note
Start Time
Start time of the session as submitted by provider in line note
Delivery Mode
Either face to face (F), video (V) or telephonic (T) as submitted by provider in line note
Submitted Program Code
Program Code submitted on the claim
Adjudicated Program Code
Program Code that was assigned to the service during claims adjudication
Staff Qualification Indicator
From the Claim Note
OHI Paid
If there is other insurance coverage, the amount paid by that coverage
Subcontractor NPI
The NPI of the entity to which services were subcontracted
Subcontractor FEIN
The Federal Employer Identification Number of the entity to which services were
subcontracted
Group ID
For group based services the group ID as assigned by the provider and sent in the line
note
# clients in Group
For group based services the number of clients in the group as sent by the provider in line
notes
# staff in group
For group based services the number of staff in the group as sent by the provider in line
notes
Staff ID
Optional Staff ID as assigned by provider in line notes
Upcoming Claims Reports
EDI 837P Management Reports
•
Report of EDI Batch Claims by Batch Submission # -Track claims volume and status by
EDI batch submission number. Detail and summary.
•
Report of EDI Batch Claims by Batch Submission Date - Track claims and submission
volume submitted on a specified date or date range. This report may span multiple
submission numbers. Detail and summary.
•
Report of EDI Batch Claims Submitted by Submitter ID - Allows a provider to see total #
of batches submitted by one or multiple submitter IDs for a selected submission date or
date range. Summary report.
Claim Status Reports – Summary and Detail
•
Report of Claims in Process by Submission Date -shows all claims still in process (not
finalized) for specified submission dates.
•
Report of Approved Claims by Submission Date - Report of finalized claim lines with
allowed amounts greater than zero for a date range, regardless of the manner of claim
submission
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Questions and Answers
59
Registration Reports
Consumer Registrations that Expire
within a specified number of days
Report Name
Description of Report
Parameters for entry
Fields Generated
IL
A Summary pdf report of
consumer registrations that
are expiring within a
specified number of days
Number of days
Submitter ID, RIN, Client
ID, Last Name, first Name,
Date of Birth, Gender,
Registration Start date,
Program Code, Expiration
Date, Expiration Indicator
Consumer Expiring
Registrations by
Submitter/RIN
IL Consumer Expiring
Registrations by
Submitter/Client ID
IL
Consumer Expiring
Registrations by RIN
IL
Consumer Expiring
Registrations by Client ID
IL
Consumer Expiring
Registrations by Expiration
Date
IL
Consumer Expiring
Registrations by Last Name
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Il Consumer Expiring Registrations
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Reg expired report with parameters
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Consumer Registrations Entered between
Begin Date and End Date
Report Name
Description of Report
Parameters for entry
Fields Generated
Il
A Summary pdf report of
consumer registrations that
were entered with a
specified time frame
Date Range – Begin date
and End date (up through
the day before)
Submitter ID, RIN, Client
ID, Last Name, first Name,
Date of Birth, Gender,
Registration Start date,
Program Code, Closure
Date, Entered Date
Consumer Registrations
Entered by Date Range by
Submitter ID/RIN
Il Consumer Registrations
Entered by Date Range by
Submitter ID/Client ID
Il Consumer Registrations
Entered by Date Range by
RIN
Il Consumer Registrations
Entered by Date Range by
Client ID
Il Consumer Registrations
Entered by Date Range by
Date Entered
Il Consumer Registrations
Entered by Date Range by
Last Name
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Consumer Registrations Entered between
Begin Date and End Date – Sample Report
Consumer Registrations Entered between 7/1/2008 and 7/30/2008 for provider 123456789
Submitter ID
999999
999999
RIN
123456789
231234535
Client ID
000001
000612
Last Name
Doe
Jones
First Name
John
Eva
Date of Birth
01/01/1990
10/09/1960
Gender
M
F
Start Date Program
07/01/2008
ABC
Closure Date
07/15/2008
Entered Date
07/30/2008
121
350
575
07/15/2008
07/15/2008
07/15/2008
07/30/2008
07/30/2008
07/30/2008
07/01/2008
ABC
350
575
07/05/2008
07/05/2008
07/05/2008
Total for Submitter ID 999999 – 2
-----------------------------------------------------------------------------------------------------Page Break----------------------------------------------------------------------------------------------Submitter ID
RIN
Client ID
Last Name
999999IL
123456321
000550
Green
Total for Submitter ID 999999IL – 1
Total All Submitter IDs - 3
70
First Name
Sam
Date of Birth
01/01/1995
Gender
M
Start Date Program
07/15/2008
ABC
350
575
Closure Date
Entered Date
07/23/2008
07/23/2008
07/23/2008
Consumer Registrations that have Expired
Report Name
Description of Report
Parameters for entry
Fields Generated
Il
A Summary pdf report of
consumer registrations
that have expired as of
the day the report was
run
None
Submitter ID, RIN, Client
ID, Last Name, first
Name, Date of Birth,
Gender, Registration
Start date, Program
Code, Expiration Date,
Expiration Indicator, #
days
Expired Registrations
by Submitter ID/RIN
Il
Expired Registrations
by Submitter ID/Client ID
Il
Expired Registrations
by RIN
Il
Expired Registrations
by client ID
Il
Expired Registrations
by Expiration Date
Il
Expired Registrations
by Last Name
71
Consumer Registrations that have Expired – Sample
Report
Report requested on 2/1/2009
Consumer Registrations that have Expired for Provider 123456789
Submitter ID
RIN
Client ID
Last Name
999999
123456789
000001
Doe
999999
231234535
000612
Jones
First Name
John
Eva
Date of Birth Gender Start Date
Program
Expiration Date Exp Ind
01/01/1990
M
07/0120/08
ABC
121
350
575
12/31/2008
12/31/2008
12/31/2008
12/31/2008
10/09/1960
F
07/01/2008
ABC
350
575
12/15/2008
12/15/2008
12/15/2008
#/Days
31
31
31
31
SASS
SASS
SASS
45
45
45
Total for Submitter ID 999999 – 2
---------------------------------------------------------------------------------------Page Break------------------------------------------------------------------------------Submitter ID
RIN
Client ID
Last Name
999999IL
123456321
000550
Green
Total for Submitter ID 999999IL – 1
Total All Submitter IDs - 3
72
First Name
Sam
Date of Birth Gender
01/01/1995
M
Start Date
08/01/08
Program
ABC
350
575
Expiration Date Exp Ind
01/31/2009
01/31/2009
01/31/2009
#/Days
1
1
1
Consumer Registrations Active on
Requested Date
Report Name
Description of Report
Parameters for entry
Fields Generated
Il
A Summary pdf report of
consumer registrations
that are active on the
date report was run
None
Submitter ID, RIN, Client
ID, Last Name, first
Name, Date of Birth,
Gender, Registration
Start date, Program
Code, Program End
Date, Closure Date
Active Consumer
Registrations by
Submitter/RIN
Il
Active Consumer
Registrations by
Submitter/Client ID
Il
Active Consumer
Registrations by RIN
Il
Active Consumer
Registrations by Client ID
Il
Active Consumer
Registrations by Last
Name
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Consumer Registrations Active on
Requested Date - Sample Report
Consumer Registrations Active on 12/20/2008 for Provider 123456789
Submitter ID
999999
999999
RIN
client ID
123456789
000001
231234535
000612
Last Name
First Name Date of Birth Gender
Doe
John
Jones
Eva
01/01/1990
10/09/1960
M
F
Start Date
Program
07/01/2008
ABC
121
350
575
07/01/2008
Program End Date Closure Date
10/21/2008
ABC
350
575
12/31/2008
12/31/2008
12/31/2008
Total for Submitter ID 999999 – 2
-------------------------------------------------------------------------------------Page Break---------------------------------------------------------------------------Submitter ID
999999IL
RIN
123456321
client ID
000550
Total for Submitter ID 999999IL – 1
Total All Submitter IDs - 3
74
Last Name
Green
First Name Date of Birth Gender
Sam
01/01/1995
M
Start Date
08/0120/08
Program
ABC
350
575
Program End Date Closure Date
Closed Consumer Registrations between
Begin Date and End Date
Report Name
Description of Report
Parameters for entry
Fields Generated
Il
A Summary pdf report of
consumer registrations that
were closed with the time
frame requested
Date Range – Begin date
and End date (up through
the day before)
Submitter ID, RIN, Client
ID, Last Name, first Name,
Date of Birth, Gender,
Registration Start date,
Program Code, Closure
Date, Closing Disposition,
Scale used at closing,
Score at closing
Closed Consumer
Registrations by Submitter
ID/RIN
Il
Closed Consumer
Registrations by Submitter
ID/Client ID
Il
Closed Consumer
Registrations by RIN
Il
Closed Consumer
Registrations by Client ID
Il
Closed Consumer
Registrations by Closed
Date
Il Closed Consumer
Registrations by Last Name
75
Closed Consumer Registrations between
Begin Date and End Date – Sample Report
Closed Consumer Registrations between 08/01/08 and 8/31/08 for Provider 123456789
Submitter ID RIN
Client ID Last Name First Name Date of Birth Gender Start Date
Program Closure Date Closing Disp Scale used
Score
999999
123456789 000001
Doe
John
01/01/1990
M
07/01/08 ABC
121
350
575
08/01/2008
08/01/2008
08/01/2008
08/01/2008
04
04
04
04
G
G
G
G
75
75
75
75
999999
231234535 000612
Jones
Eva
10/09/1960
F
07/01/08 ABC
350
575
08/12/2008
08/12/2008
08/12/2008
05
05
05
G
G
G
82
82
82
Total for Submitter ID 999999 – 2
--------------------------------------------------------------------------------------------------Page Break-------------------------------------------------------------------------------------------------Submitter ID RIN
999999IL
Client ID Last Name First Name Date of Birth Gender Start Date
123456321 000550
Total for Submitter ID 999999IL – 1
Total All Submitter IDs - 3
76
Green
Sam
01/01/1995
M
08/01/08
Program Closure Date Closing Disp Scale used
ABC
350
575
08/31/2008
08/31/2008
08/31/2008
06
06
06
C
C
C
Score
79
79
79
Consumer Registrations for RIN
Report Name
Description of Report
Parameters for entry
Fields Generated
Il
A Summary pdf report of
consumer registrations
for specified consumer
Consumer’s RIN
Submitter ID, RIN, Client
ID, Last Name, first
Name, Date of Birth,
Gender, Registration
Start date, Program
Code, Program End
Date, Closure Date
Consumer
Registration for specified
RIN
77
Consumer Registrations for (RIN) – Sample Report
Consumer Registrations for 231234535 for Provider 123456789
Submitter ID
RIN
999999
231234535
Client ID
Last Name
000612
Jones
First Name
Eva
Date of Birth Gender
10/09/196
F
Start Date Program Program End Date Closure Date
07/01/2008
ABC
121
575
09/15/2008
Total for Submitter ID 999999 – 1
--------------------------------------------------------------------------------------------Page Break-----------------------------------------------------------------------------------------------------------------------Submitter ID
RIN
999999IL
231234535
Client ID
Last Name
000612
Jones
Total for Submitter ID 999999IL – 1
Total All Submitter IDs - 2
78
First Name
Eva
Date of Birth
Gender
10/09/1960
F
Start Date Program Program End Date Closure Date
12/10/2008
ABC
575
Registration Excel Data Sets
Registration Detail –Excel format data sets of registrations that can be
saved to Provider’s desktop and sorted according to provider’s
preference.
There will be 2 data sets – One containing Enrollment information and the
other containing Clinical information
Select by Registration Start Date or Date Entered. A specific date or date
range is required to limit data set size.


79
Data Set is limited by Excel’s limitations.
Providers need to plan timing and approach to extracting data
IL Consumer Registration Enrollment Data
80
Registration Number
Marital Status
Path Grant Begin Date
MH Registration Date
Employment Status
Path Grant End Date
Consumer ID (Recipient
RIN)
SSI-SSDI Eligibility
CHIPS Begin Date
Last Name
DFI-CFI Enrollment
CHIPS End Date
Client First Name
Court / Forensic Treatment
Consumer Residential Program
Begin Date
Client Middle Initial
Race #1
Consumer Residential Program End
Date
Name Suffix
Race #2
Guardian 1 Type
Birth Date
Race #3
Guardian 1 First Name
Social Security Number
Race #4
Guardian 1 Middle Initial
Mother’s Maiden Name
Race #5
Guardian 1 Last Name
Gender
Hispanic Origin
Guardian 1 Address
Client ID
Language
Guardian 1 City
Agency FEIN
Citizenship
Guardian 1 State
IL Consumer Registration Enrollment Data
(con’t)
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Satellite Code
Interpreter Services Needed
Guardian 1 Zip Code
Medicaid Site ID
MH Residential Indicator
Guardian 1 Zip Code Suffix
Primary Address
MH Residential Arrangement
Guardian 1 Appointment Date
Address Line 2
Justice System Involvement
Guardian 1 Termination Date
City
Disaster Guest Type
Guardian 2 Type
State
Disaster Guest State
Guardian 2 First Name
Zip Code
Disaster County
Guardian 2 Middle Initial
County
Consumer third party payor?
Guardian 2 Last Name
Township/Community Area
Special Program Enrollment Juvenile Justice Program
Guardian 2 Address
Household Income
Special Program Enrollment PATH Grants
Guardian 2 City
Client Income
Special Program Enrollment Comm Hosp Inpatient
(CHIPS)
Guardian 2 State
Family Household Size
Special residential program
Guardian 2 Zip Code
Household Composite
Residential level of care
Guardian 2 Zip Code Suffix
Education Level
Juvenile Justice Begin Date
Guardian 2 Appointment Date
Military Status
Juvenile Justice End Date
Guardian 2 Termination Date
IL Consumer Registration Clinical Data
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Registration Number
CGAS - Self Care
History of Illness - Multiple Residential
MH Registration Date
CGAS - Community
History of Illness - Outpatient
Consumer ID (Recipient RIN)
CGAS - Social Relations
History of Illness - Previous Treatment
Last Name
CGAS - Family Relations
Co-Occurring Disorders
Client First Name
CGAS- School
Evidence Based Practice - Supported Employment
Client Middle Initial
GAF-Social Group/School
Evidence Based Practice - IDDT
Name Suffix
GAF-Employment
Evidence Based Practice - Medication Algorithm
Birth Date
GAF-Financial
MH Cross Disabilities Database -Form Completion Date
Gender
GAF-Community Living
MH Cross Disabilities Database -Primary Care Giver Age
Client ID
GAF-Supportive Social
MH Cross Disabilities Database -Type of Services Needed
1
MH Diagnosis Code Type
GAF-Daily Living Activity
MH Cross Disabilities Database -Type of Services Sought 1
IL Consumer Registration Clinical Data (con’t)
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MH Axis 1 Diagnosis 1
GAF-Inappropriate or Dangerous
Behavior
MH Cross Disabilities Database -Type of services Needed 2
MH Axis 1 Diagnosis 2
GAF-Previous Functional Impairment
MH Cross Disabilities Database -Type of Services Needed 3
MH Axis 1 Diagnosis 3
LOCUS - Risk of Harm
MH Cross Disabilities Database -Type of Services Sought 2
MH Axis 2 Diagnosis 1
Recovery-Environment-Stressor
MH Cross Disabilities Database -Type of Services Sought 3
MH Axis 2 Diagnosis 2
Recovery Environment-Supports
MH Cross Disabilities Database -Type of Services Needed Other
Description
MH Axis 2 Diagnosis 3
Functional Status
MH Cross Disabilities Database -Type of Services Sought Other
Description
MH Axis 3 Diagnosis 1
Co-Morbidity
MH Closing Date
MH Axis 3 Diagnosis 2
Recovery and Treatment History
MH Closing Disposition
MH Axis 3 Diagnosis 3
Acceptance and Engagement
Functional Scale Used at Closing
MH Principal Diagnosis Indicator
Level of Care Recommended Assessors
GAF/CGAS Score at Closing
Functional Scale Used
History of Illness - Continuous
Treatment
GAF/CGAS Score
History of Illness - Continuous
Residential
Questions and Answers
84
Thank you!
Illinois Mental Health Collaborative for
Access and Choice