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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?