Mediware Information Systems, Inc.11711 West 79th Street, Lenexa, Kansas 66214 | Mediware.com | 1.888.Mediware©2015 Mediware Information Systems, Inc. All Rights Reserved. Confidential and Proprietary.Last Update Date- Jun. 30, 16

Patient Target Pops

This document explains the steps to manually create or update a consumer’s target population and the automation of target pop selection by the AlphaMCS system. This module is used to provide the state with new and updated information on consumer target pops as well as remove inaccurate information. For more information, please visit the links below:

http://www.ncdhhs.gov/mhddsas/providers/IPRS/

Automation

Certain target pops (AMI, CMSED, ASTER, CSSAD, and GAP) are automatically added to the consumer’s target pop record by AlphaMCS, as long as there are no concurrency issues. The system will use age and primary dx information from Enrollments, CUR’s, Authorizations, and Claims for target pop determination. This essentially means that there will be target pops in the consumer’s record that were not added by the MCO manually. (Example: a claim comes in with a dx previously not in the client’s record. If the claim approves, that dx will be added to the client record, which means the system will then look to see 1) if the TP for that dx and age group is already there, 2) if not, if there are concurrency issues with any TPs that the client currently has. If there aren’t, that TP will be added.)

To create, update or delete a Target Pop manually, first navigate to the module.

After using the patient filter to locate your consumer, navigate to the IPRS Target Pops Tile by clicking the consumer’s name (to activate) then choose Doc, Assignments.

Click, hold and drag the tile over to the middle of the screen, or simply click the white box w/ and outward arrow

to expand.

Mediware Information Systems, Inc.11711 West 79th Street, Lenexa, Kansas 66214 | Mediware.com | 1.888.Mediware©2015 Mediware Information Systems, Inc. All Rights Reserved. Confidential and Proprietary.Last Update Date- Jun. 30, 16

Patient Target Pops

Choose Create to add a new TP or you can choose to Filter if this consumer has a lenghty history

Filter for a TP when consumer has a lengthy history:

Creating New TP to send to IPRS Sample:

** When choosing a TP, select it from the prepopulated dropdown, do not manually type raw data due to matching and validation issues. Also, “Send to IPRS” is checked by default. You can choose to send another time by unchecking.**

Updating a current TP

Mediware Information Systems, Inc.11711 West 79th Street, Lenexa, Kansas 66214 | Mediware.com | 1.888.Mediware©2015 Mediware Information Systems, Inc. All Rights Reserved. Confidential and Proprietary.Last Update Date- Jun. 30, 16

Patient Target Pops

Update screen will appear to make the desired changes.

Now if we go back to the record after it has been sent out on an 834 and the State accepted the change, it will look like below. Notice the IPRS accepted is checked, the Effective and End dates are updated with the date the record was sent in the “Sent to IPRS Date” field:

Technical InfoThe interaction between AlphaMCS and the State starts with an MCS system process that compiles all updates into an 834 file which is placed in the MCOs Out folder. This file will include new(021), update(026) and delete(002) records and the MCO must manually move this file to the IPRS mailbox. Files are created daily and should be submitted daily. If these files are not submitted, billing/encounter reporting will deny for clients that have not been submitted.