• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
World Wide Tour: Bridging the Gap Between VaCMS and MMISJessica Annecchini, MA Consultant, VDSS
Ruth Mulkey, Supervisor, Enrollment Unit, DMAS
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
2Agenda
VaCMS
VaCMS Screens:
VaCMS/MMIS Failures
ClientDemographics
Alien Third Party Resources
CertificationPeriod Override
MMIS Individual Details
MMIS Transaction History
Match MMIS Case/Enrollee IDs in VaCMS
How to Read Failures How to Resend Transactions
When to Send a Ticket Running RCR
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
3Acronyms
AC – Aid Category
EDBC – Eligibility Determination Benefit Calculation
EDG – Eligibility Determination Group
MMIS – Medicaid Management Information System
NB – Newborn
NPI – National Provider Identifier
QRG – Quick Reference Guide
RCR – Retro Cancel Reinstate
TPL – Third Party Liability
VaCMS – Virginia Case Management System
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
4VaCMS Screens
Client Demographics
• Citizenship Verified Through Deemed NB
• NPI
• Type of Medical Assistance Mother Received or Expected to Receive at the Time of Child Birth
Alien
• Verification Source
• Alien Category
• Foreign Passport Country of Issuance
• Emergency/Restricted Coverage Dates
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
5VaCMS Screens
Third Party Resources
• Carrier Code
• Policy #
• Ending Policies
Certification Period Override
• If not updated by system can use this feature
• Must know EDG# and Case#
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
6VaCMS Screens
MMIS Individual Details
• The only place to make a new enrollee ID and case number for local agency
• Updates relationship
• The ability to assign a new enrollee ID is only available the first time a case is authorized
MMIS Transaction History
• Shows failures
• Shows who authorized the case in some case actions
• Where you resend failures
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
7VaCMS Screens
Match MMIS Case/Enrollee IDs in VaCMS
• After individuals are authorized, this is the screen you can use to fix certain failures
• This screen does a point in time match with MMIS if information is changed to ensure it matches
• If you have to move someone from one MMIS to another, you will have to go in MMIS first, then come to this screen
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
8VaCMS/MMIS Failures
How to Read Failures
• Hover over failure code and text will appear
• Selecting the Resend button will give more information on fix
Top Failure Reasons
Before authorization:
o Mother ID
o Language
o NPI
After Authorization:
o Valid Case/Enrollee ID
o TPL failures
o Possible Duplicates
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
9VaCMS/MMIS Failures
How to Resend Failures
• Click resend link
• Read fix suggestions and use VaCMS and MMIS to fix issue
• May have to navigate to Match MMIS Screen first
• Always to go MMIS Individual Details to finish the resend
When to Submit a Ticket
• When the resend does not complete
• If the Match MMIS or MMIS Individuals screen do not update successfully
• If the failure that is before authorization cannot be cleared
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
10VaCMS/MMIS - RCR
Running RCR
• Eligibility must be on current case and can only run up to 12 months in the past
• Can be used for things like closure 12 in MMIS, gaps in coverage, and some failed transactions
• Can only be performed in Case Change/Closure Case Action
• On the Wrap Up - Run Eligibility Screen, enter a date in the “Run EDBC From” field
• Changes that result in a change in AC will be reflected in Eligibility Summary; changes that do not result in AC change or are higher to lower coverage, show authorization as “No Action Needed”
• If resending a transaction you will have to complete an override and re-run eligibility exactly the same way
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
11VaCMS/MMIS - RCR
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
12VaCMS/MMIS Failures
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
13Resources
QRGs:
Reinstating a Program
Retro Cancel Reinstate
Changing a MA Renewal Date
Preventing Common MMIS Transaction Failures
MMIS Transactions - Resending
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
14Questions
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
Contact Information:[email protected]
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
WORLD WIDE TOUR: BRIDGING THE GAP
BETWEEN VACMS AND MMIS
NAVIGATING IN MMIS -
MEMBER MANAGEMENT INFORMATION
SYSTEM
BPRO Spring Conference
Roanoke, VA
May 29 – 31, 2019
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
What Can A Worker Do in MMIS?
• Edit/update Member and Case Information
– Member/Case Demographics Screen
– Citizenship, Identity, SSN, Address
• Move a Member from one case to another
• Conduct Inquiries
• Help Feature
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
MEMBER DEMOGRAPHICS – INQUIRY
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
ELIGIBILITY DATA - INQUIRY
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
SCREEN HELP
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
Selecting thehyperlink
for the field provides
details of the data listed
SCREEN HELP – Hyperlink Level
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
CITIZENSHIP STATUS
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
Citizenship Status
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
CITIZENSHIP LEVEL
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
Citizenship Levels
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
IDENTITY
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
Identity
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
MMIS Coverage Correction Request Form
Coverage Change Requested
Indicate the missing coverage needed to be entered
FPL STATUSIncome < 100 % FPL
“Y” or “N”
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
DMAS Enrollment Unit
BROADCAST dated 3/26/2019Corrective Information Related to MMIS Enrollment
Enrollment Unit staff has been diverted to process the following requests:
• Urgent MMIS Coverage Corrections that can't be handled by the Regional Consultant;• Same Day Voids;• Enrollment of pregnant women that can't be handled by the Regional Consultant;• Patient pay corrections
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
Where to Send Forms?
Coverage Correction Forms
Patient Pay Correction Forms
TPL Questions
Buy-In Questions
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
THANK YOU!
Ruth MulkeySupervisor, Enrollment Unit
(804) [email protected]
