Post on 22-Dec-2015
transcript
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Business Objects
CCS PAID CLAIMS REPORTING
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Under the new (E47) CCS Service Authorization Process
1. The County Case Manager generates a Service Authorization
2. The Provider enters the Service Authorization Number on their claim
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This new process has increased our need for
Post-payment monitoring
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Examples of what you have asked to see:
Expenditures by Case Provider Diagnosis Procedure Code
Funding Source Medi-Cal CCS-only Healthy Family
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A new CCS claims reporting system is under development
Business Objectssoftware will allowusers to view historical claims information through a secured WEB site
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CMS already has three
Reporting Systems that operate with Business Objects…
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1. CCS:
Reports from CMS NET Legacy
‘Snapshot’ Updated Nightly Does not contain every data
elements in CMS Net Legacy
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CCS Business Objects includes:
Number of Clients by Status
Caseload by County Case Manager
Client Eligibility
Other Health Coverage
Client Diagnosis (as entered on Patient Registration Screen)
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2. CHDP:
Reports from Claims History
July 1, 2002 to present Updated Monthly Includes the CHDP
Provider Master File
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3. CHDP Gateway:
Reports from the Gateway Pre-Enrollment Application Form and
MEDS
July 2003 to present Updated weekly
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The NEW CCS Claims Reporting System will contain:
12 months of Paid Claims history
Provider Master File
Monthly updates
All data elements carried on the Claim Form
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Objectives of the New Reporting System
Effective use of program funds
Effective and efficient case management through oversight of CCS program activities
Assessment of outcomes and determination of trends
Quality provision of services
(Were the services rendered by CCS-approved providers?)
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Examples of Reports
Procedure codes paid at the claims detail level (replacement of MR-0-910/940)
Counts and Dollars paid by Provider ID
Services paid under EPSDT SAs
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Examples (cont.) Claims by procedure code and
CCS ID Number for comparison against Patient’s ICD-9 in CMS Net
Dollars paid by aid code
Summary and Detail MTU reports (CCS provider prefix)
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To view these reports you will need:
1. Internet Access
2. A Business Objects password from the State
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Security
You will be able to view claims information for children only within your county
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Step 1 Enter your Business Objects User Name and Password
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Step 2 Click on the Business Objects ‘LogIn’ Button
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Step 3Pick the Reporting System
that you want to see
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Step 4 Click on report title to see the Report
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Example of a CMS Net Corporate Report
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Example of a Business Objects Claims History Report
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Roll-out Phase I
Corporate Reports View and Print
Fixed and Prompted
State staff will create Ad Hoc reports for you
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Phase II
Link the CMS Net Legacy & CCS Claims Reporting Systems
Link the CCS Claims Reporting system with the Special Care Center SARs
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Questions or Comments?