MACSIS HIPAA Member Training

MACSIS HIPAA Member Training MACSIS HIPAA Member Training

Introduction • In order to pay claims, clients must be enrolled in MACSIS. • Only those clients receiving behavioral health services funded in whole or in part with public funds administered through the boards should be enrolled in MACSIS. • Board staff must perform member maintenance on a regular basis to correct member information so that claims pay properly. • This includes the correct group, plan, panel, line of business, rider codes, eligibility spans, etc. MACSIS HIPAA Member Training

Agenda • Member Enrollment • Member Enrollment Form • Residency Verification Form • Entering a member in Diamond • F6-Z View/Maintain Additional Member Fields • F4 Notes • Member/Claims Transfers • Member Maintenance • Board changes • Nightly Updates • Member Reports • Residency • Out-of-County Enrollments • Removal of Client Data from MACSIS • Affiliation Codes • Pseudo UCI’s MACSIS HIPAA Member Training

Member Enrollment Form • Client presents for service. • Provider completes the New Member Enrollment form. • County of residency is determined. • Residency Verification form is completed and signed if required. MACSIS HIPAA Member Training

Member Enrollment Form (cont’d) Submit enrollment form to appropriate board. Board receives enrollment form and checks form for completion. If incomplete – return form to provider with an explanation of what data is missing. If complete – enroll the client following the “Enrolling a Client” flowchart. MACSIS HIPAA Member Training

New Member Enrollment Form MACSIS HIPAA Member Training

Completion of Enrollment Form (cont’d) MACSIS HIPAA Member Training

Residency Verification Form Completion Purpose: To clarify which county is responsible for adjudicating claims for behavioral health services provided to the client being enrolled. When: It should be completed and provided to the enrolling board when: • The county of the treating facility does not match the legal county of residence of the client as noted on the enrollment form (child or adult, out-of-county). • The physical address of the client as noted on the enrollment form does not match the legal county of residence of the client (example: domestic violence shelter case, client temporarily living with relatives, child or adult, out-of-county). • The child’s physical address as noted on the enrollment form does not match the legal custodian’s address (child only, in or out-of-county). A client’s or legal custodian’s signature on this form shall be sufficient for documenting residency with the exception of adults who reside in specialized residential facilities or who are committed pursuant to special forensic categories referenced in the residency guidelines.* MACSIS HIPAA Member Training

Residency Verification Form MACSIS HIPAA Member Training

Enrollment/Residency Verification Form • There is a minimal data set required for enrolling a client who is in crisis into MACSIS. • Last name • First name • Date of birth (use default if unobtainable – 7/4/1876) • Gender • Boards should not refuse to enroll a client who is in crisis where the provider was unable to complete the enrollment form or residency verification form and “Client in Crisis at time of enrollment?” is checked on the enrollment form. • Board should enroll client • Provider should get the information from the client once the client is out of crisis and forward the completed enrollment form and residency verification form (if required) to the board. • This does not mean crisis providers do not have to try and get this information. MACSIS HIPAA Member Training

Enrolling a Client MACSIS HIPAA Member Training

Entering a Member in Diamond • Board staff accesses the Diamond keyword MEMBR. • The number one priority of board staff is to make sure that we do not enter duplicate members into Diamond. • Each potential enrollment should be looked up to make sure the client is not already in the system. • Do not limit yourself to just one search option MACSIS HIPAA Member Training

Entering a Member in Diamond (cont’d) • EXINQ Search • From the MEMBR screen access EXINQ (external eligibility inquiry) by pressing F6-X • 3 suggested inquiries are: • Medicaid number (if known) • First character of the last name and DOB • Enter a question mark in the Medicaid number field and client’s social security number • If the client is in EXINQ and is already enrolled the UCI number will be displayed in the UCI field MACSIS HIPAA Member Training

Entering a Member in Diamond (cont’d) • EXINQ Search (cont’d) • If the client is in EEI (EXINQ) and is already enrolled, access the UCI in MEMBR • Edit/add any necessary eligibility spans • Return UCI to provider • If the client is in EEI and not yet enrolled, enter “Y” to enroll. • Edit/add any necessary eligibility spans • Return UCI to provider MACSIS HIPAA Member Training

Entering a Member in Diamond (cont’d) • Member Search • If client is not in EEI, search member in Diamond using F3 (overview screen) • Mandatory searches are Last Name, Social Security Number and Date of Birth • If client is not in Diamond, enroll member in Diamond and return the UCI number to provider. MACSIS HIPAA Member Training

How to Search for a Member • Search by last name, first name – from the member screen choose F3 (Overview scrn), in upper case enter last name, comma, space then first name. Hit enter twice. • Search by SSN – from the member screen choose F3, then hit F3 four more times and enter the SSN. Hit enter twice. • Search using DOBRC – from the member screen choose F3, hit F3 seven more times. Enter date of birth like mmddyyyy. Hit enter twice. • Search using the EMP field – from the member screen choose F3, hit F3 one more time. Enter the Employee # which is the first 3 initials of the last name, date of birth and gender (XXXmmddyyF). • Search using MEDELIG – from the member screen choose F6 (SpecFuncts), then select X (External Eligibility Inquiry) then hit enter. If you have the Medicaid ID you can enter and search on that. If you do not have the Medicaid ID, it is best to search on the first two letters of their last name and date of birth. You can search on SSN only by entering a ? In the Medicaid ID field and the SSN. MACSIS HIPAA Member Training

Diamond Keyword MEMBR MACSIS HIPAA Member Training

EXINQ Screen MACSIS HIPAA Member Training

EXINQ- Member Found MACSIS HIPAA Member Training

Completing the Member Screen • Instructions for completing the member screen are contained in the Member Section of the Board Operations Manual and the step-by-step document “Completing the Member Screen”. • Key things to remember: • UCI is automatically assigned • Person no. is always 00 • All values should be entered in all caps • Last Nm field – only special character allowed is a dash for hyphenated last names • Start date should be the start date on the enrollment form. • Never enter future dates – the nightly update process can only update the current span, entering future dates would keep the member from being updated. MACSIS HIPAA Member Training

Special Functions – F6 • From the main member screen there are several special functions that are accessed by selecting F6. The most commonly used ones are: • T = Terminate/Unterminate • R = Reinstate • E = View/Maintain Elig History • B = Display Benefit Accumulators • X = External Eligibility Inquiry • Z = View/Maint Additional Member Fields MACSIS HIPAA Member Training

F6-E = View/Maintain Elig. History MACSIS HIPAA Member Training

B = Display Benefit Accumulators MACSIS HIPAA Member Training

X = External Eligibility Inquiry MACSIS HIPAA Member Training

Z = View/Maintain Additional Member FieldsScreen 1 If you are including member information on this screen, a “Z” should be entered in the first position of the COUNTY field on the member screen. MACSIS HIPAA Member Training

Z = View/Maintain Additional Member FieldsScreen 2 MACSIS HIPAA Member Training

F4 Notes • This function is available from the main member screen or directly from the main menu. • You should only enter NOTES from the main menu when the NOTE TYPE is NOTES. The note will not be linked to a specific keyword • The Notes keyword can be used to enter new notes or edit existing notes. • This keyword includes a header section, a detail section and the actual note/text section. • Header section is used to enter search criteria • Detail section is used to add new notes or edit existing notes. • Notes/text section is where you can add a free text note • Additional information concerning Notes is available from Diamond Help. • From the Notes screen enter F1 MACSIS HIPAA Member Training

F4 Notes – Initial Screen If there are no existing notes nothing will be displayed here. To edit a NOTE, highlight the note and select <Enter>. MACSIS HIPAA Member Training

F4 Notes – Note Detail Hit <End> to go to the actual note/text. MACSIS HIPAA Member Training

F4 Notes – Note Text When you have completed entering the text, select F4 Exit and you will return to the Note Detail screen. Where you will need to save the note. MACSIS HIPAA Member Training

Entering Notes • If you are in the keyword MEMBR when you enter a note, NOTE TYPE will be populated with MEMBR. • If you enter a note from the main menu the only NOTE TYPE that is valid is “Notes”. Notes that are to be linked to a keyword should not be entered from the main menu. MACSIS HIPAA Member Training

Entering Notes (cont’d) • To enter a new note from the main MEMBR screen, enter the client’s UCI number and bring up the member information • Hit F4 twice • The Note Type, Subscriber, Provider, Source ID and Group will automatically be populated. • Hit <Enter> and the Note ID field will be populated with the next note number. • Enter a Note Desc if desired or hit <Enter> • The Eff Date will automatically populate with today’s date • This date can be overwritten with the desired date MACSIS HIPAA Member Training

Entering Notes (cont’d) • Enter Term Date (optional) • Enter a security code (optional) • Complete any relevant information in User Defined Fields • You must enter through all of the User Defined Fields (whether you are populating them or not) in order to bring up the Notes text field. • Enter information in the Notes text field – when finished select F4 to exit the screen. • Enter “Y” to Update (save) the note MACSIS HIPAA Member Training

Editing Notes • To edit a note from the main MEMBR screen, enter the client’s UCI number and bring up the member information • Select F4 from the MEMBR screen • Only use the NOTES keyword from the main menu to edit notes that have the NOTE TYPE of NOTES. • Enter any search criteria (optional) or enter through the 3 search fields • A list of the current notes will then be displayed MACSIS HIPAA Member Training

Editing Notes (cont’d) • Select the note you wish to edit and select <Enter> • Edit any fields in the “Read/Write Notes” or “User Defined Fields” • To edit the text field select <End> • Enter “Y” to Update (save) the changes. MACSIS HIPAA Member Training

MHIST Keyword • Provides an audit trail of demographic and eligibility changes made to a member. • Enter Subscriber (UCI) and Person 00 • From date and thru date are optional • This will bring up a list of changes made to the member • Arrow or page down to find the entry you want to check • Highlight/select the change you want to view and press enter • This brings up the main member screen with the information that was in the member fields after the changes were made on that date, initials of the person making the change, type of change and date of the change. MACSIS HIPAA Member Training

MHIST Keyword MACSIS HIPAA Member Training

MHIST Results MACSIS HIPAA Member Training

Member/Claims Transfer • There will be times when a county (County “A”) will need to take over a member who is enrolled in another board’s (County “B”) group/plan. • Client has moved from one county to another • Legal guardian has moved • Client is in jail in other than the home county and that county has agreed to pay for services • Client is “homeless” • Etc. MACSIS HIPAA Member Training

Member/Claims Transfer (cont’d) • Once County “A” has determined that a client is now a resident of their county or have agreed to take over financial responsibility for a client, they should: • Terminate the client’s current eligibility span by choosing F6-T • Enter a termination date and the term reason code of MBMOV (member has moved out of county) • Reinstate the client by choosing F6-R • Enter a start date, your board’s group, plan, rider, panel and any other information that may need changed. • Save/Update the information MACSIS HIPAA Member Training

Member/Claims Transfer (cont’d) • County “A” should then notify County “B” that they have assumed financial responsibility for the client and the effective date of the change. • County “A” should also indicate whether they prefer any potential outstanding claims they may be receiving be put on hold. MACSIS HIPAA Member Training

Member/Claims Transfer (cont’d) • Upon notification of client transfer, County “B’s” claims staff should check claims history (PSDSP) for any claims incurred from the date of transfer to the present • Reimbursement for claims already finalized must be billed to County “A” via a manual invoice • Do not reverse and split the original claim • Un-finalized claims can be corrected so that they are paid by County “A”. • To correct these claims the header must be refreshed, the claim re-priced and re-adjudicated and the correct security put on the claim. (If requested place the claim on hold with a hold reason of CLMAN). (For further information about claims correction refer to the Claims Correction Procedure which can be found on the web at: http://www.mh.state.oh.us/ois/macsis/claims/macsis.hipaa.claim.correction.proc.pdf MACSIS HIPAA Member Training

Member/Claims Transfer (cont’d) • County “B” should notify County “A” when the claims have been corrected and now carry the new board’s security. • A list of the claims that have been corrected should be provided to County “A”. • County “A” should then review these claims for appropriate adjudication and remove any holds prior to APUPD MACSIS HIPAA Member Training

Member/Claims Transfer (cont’d) • The member transfer form and instructions for completing member/claims transfer are located on the MACSIS website. • The Transfer form can be found at: http://www.mh.state.oh.us/ois/macsis/member/member.claims.xfr.req.form.pdf • The instructions for completing member/claims transfer can be found at: http://www.mh.state.oh.us/ois/macsis/member/proc.claims.member.xfr.pdf MACSIS HIPAA Member Training

Member/Claims Transfer Form MACSIS HIPAA Member Training

Correcting Members • There are three main types of member corrections that routinely need to be made: • General Information – demographic information such as address, DOB, race, etc. • Other Identification ID’s – Medicaid ID, SSN, MedRec, etc. • Latest Coverage – eligibility information such as rider, group, plan, etc. MACSIS HIPAA Member Training

Correcting Members (cont’d) • When the information in the General Information or Other Identification ID’s section needs to be corrected for a member, access the member screen (keyword MEMBR), enter the UCI number, bring up the client information and make the appropriate changes and save the changes. MACSIS HIPAA Member Training

MACSIS HIPAA Member Training