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ILLINOIS IT Refresher Training

ILLINOIS IT Refresher Training. Training Agenda. 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

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ILLINOIS IT Refresher Training

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  1. ILLINOIS IT Refresher Training

  2. Training Agenda • 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

  3. DMH Introduction Presenter: Mary E. Smith, Ph.D.

  4. Introduction • 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

  5. Consumer Eligibility Files Presenter: Terry Schoonover

  6. Eligibility Files • Recipient Eligibility File • Williams Class Consumer Eligibility File

  7. Recipient Eligibility File • 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)

  8. Williams Class Consumer Eligibility File • 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)

  9. VO Data Exchanges with HFS Presenter: Terry Schoonover

  10. HFS Claims Processing Overview • 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

  11. VO Data Exchanges with HFS • 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)

  12. Consumer Registration • 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 Registration file VO HFS Registration Response file HFS VO

  13. OBRA Code • 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 OBRA file VO HFS OBRA Response file VO HFS

  14. Clinical Authorization • 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 Clinical Auth file VO HFS Clinical Auth Response file VO HFS

  15. Provider Site Fund Codes • 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. Site Fund Changes VO DMH Forwarding Site Fund Changes VO HFS

  16. MARS File • 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

  17. ProviderConnect RegistrationPresenter: Amy Montgomery

  18. ProviderConnect • 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

  19. How to Access ProviderConnect • 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

  20. ProviderConnect Online Registration 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

  21. Registration Direct Submission • Red Dot Error Example

  22. Registration Direct Submission • Successful Submission Confirmation Example:

  23. Live Demo

  24. Batch Registration Presenter: Trish Gorda

  25. 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 ….. • 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.

  26. Where do I Find the Guide? • On the Collaborative Website at: • http://www.illinoismentalhealthcollaborative.com/provider/prv_information.htm

  27. Let’s Get Started!

  28. EDI Homepage

  29. Step 1 - Select the Form Type

  30. Step 2 - Click Next…..

  31. Step 3 – Attach the File and Submit

  32. Step 4 - File Successfully Sent!

  33. Batch File Rejection Errors • 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.

  34. Response Files • 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.

  35. Retrieving Response Files

  36. EDI Homepage

  37. View Incoming Files

  38. File Downloaded Successfully?

  39. Unsuccessful? Try Again!

  40. Viewing Consumer Funds Presenter: Terry Schoonover

  41. Viewing Consumer Funds • After a consumer is registered, the funds can be viewed • Start from ProviderConnect Home as seen below

  42. Viewing Consumer Funds • Enter Consumer ID (RIN) and Date of Birth

  43. Viewing Consumer Funds • On the Demographic page, click “View Consumer Registrations”

  44. Viewing Consumer Funds • Funds are listed with date range • To find the ABC benefit package assigned, click the “ILAS” link that corresponds to the ABC fund

  45. ABC Benefit Package • 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

  46. ABC Benefit Package Guide

  47. IT Customer Support Presenter: Terry Schoonover

  48. Customer Support Telephone Numbers • This guide is posted to the “In the Spotlight…” section of the Collaborative website at http://www.illinoismentalhealthcollaborative.com

  49. Multiple RIN Resolutions • 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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