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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.

Purpose of Training◦ Refresher/Review of Key Processes◦ Availability of Resources and Tools

Registration Design◦ Data Elements

Use of Registration Data◦ Decision Support and Planning◦ Federal Reporting◦ Ability to look at change across time

Timely Submission of Registrations

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Presenter: Terry Schoonover

Recipient Eligibility File

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

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

OBRA Codes (reimbursement rate for ABC fund)

Clinical Authorization

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

HFS processes file (accepts or rejects) and sends results to VO by the 2nd business day

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Registration file

Registration Response file

VO

VO

HFS

HFS

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

◦ HFS processes file (accepts or rejects) and sends results to VO by the 2nd business day

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OBRA file

OBRA Response file

VO

VO

HFS

HFS

VO processes the authorization request VO sends the approved authorizations to

HFS within 1 business day.

HFS processes file (accepts or rejects) and sends results to VO by the 2nd business day

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Clinical Auth file

Clinical Auth Response file

VO

VO

HFS

HFS

These are funds that a site has available to use for claims reimbursement (ABC, 821, etc.).

DMH sends site fund code changes to VO.

VO updates the record in the VO system. VO then forwards the change to HFS, so the

HFS system can be updated as well.

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Site Fund Changes

Forwarding Site Fund Changes

VO

VO HFS

DMH

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

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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 a RIN and DHS Social Services (DHS SS) for the consumer through E-Rin System

•In 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

OverviewPlease Note: This portion of the document will step through the basics of submitting a batch registration file using ProviderConnect. For detailed information regarding …..

•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

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.

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

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

Benefit Package Assigned

Clarification

1st Presentation Indicated ‘Yes’

ABC – 1st SMIIf 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)

Eligibility Status is TADL and 1st Presentation is ‘No’

ABC – Target Adult

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)

Eligibility Status is TCHD and 1st Presentation is ‘No’

ABC – Target Child

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)

Eligibility Status is ELIG and 1st Presentation is ‘No’

ABC – EligibleBeing 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

This guide is posted to the “In the Spotlight…” section of the Collaborative website at http://www.illinoismentalhealthcollaborative.com

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Reason For Call Contact Number To UseClaims/Billing Issues before or after 7/1/11 HFS Claims Transition

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

Service Authorization-For a provider to pre-authorize care-Inquire about an existing authorization

The Collaborative (866) 359-7953, select the provider menu, then press 1.

Registration questions (technical or nontechnical in nature) Technical difficulty with the Collaborative system such as: -Account disabled-System “freezing” or crashing-System unavailable errors

EDI Help Desk (888) 247-9311

Utilization Management (Clinical) The Collaborative (866) 359-7953, select the provider menu, then press 1.

IntelligenceConnect Reporting Issues EDI Help Desk (888) 247-9311No RIN or Social Service Package B Issues

DHS/Customer Support:Jay Hidalgo (800) 385-0872

Multiple RIN Issues The Collaborative (866) 359-7953, select the provider menu, then press 1.

DMH Policy Issues DMH Regional Staff

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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