1 Department of Medical Assistance Services Department of Medical Assistance Services – Eligibility and Enrollment Unit June Department of Medical Assistance Services MMIS WebEx Training

2 Department of Medical Assistance Services Agenda Third Party Liability (TPL) Health Insurance Premium Payment (HIPP) TPL Medicare Part A Emergency & Dialysis Services CCC Addresses MMIS Duplicate Member Process Overlays

3 Department of Medical Assistance Services TPL A TPL policy is a health or long-term care insurance in which a member is enrolled. Applicants must be asked to provide information about any health or long-term care insurance they have which is entered into the MMIS TPL file.

4 Department of Medical Assistance Services TPL (continued) Questions regarding TPL issues (not related to Medicare) carrier codes, verification of termination of a policy and handling cases with more than five current policies contact the TPL Unit: Third Party Liability Unit, 8th floor 600 E Broad Street, Suite 1300 Richmond VA Phone: Fax:

5 Department of Medical Assistance Services TPL (continued) End Dating TPL vs. Retiring TPL: –End date the policy and the coverage when it is no longer active. –Retire* the policy if it was added in error and never existed. *Note: While this is referred to as “retiring” a policy in the MMIS, this process is only used when the policy NEVER existed for the member and needs to be DELETED.

6 Department of Medical Assistance Services TPL (continued) Select TPL Resource Inquiry/Update Select Add Select Enter Select TPL Resource Inquiry/Update Select Add Select Enter

7 Department of Medical Assistance Services TPL (continued) Mandatory Fields: Member ID Source Policy Number Rel Policy Type Carrier Code Status Begin Date Verify Cov Begin Date End Date if applicable Mandatory Fields: Member ID Source Policy Number Rel Policy Type Carrier Code Status Begin Date Verify Cov Begin Date End Date if applicable

8 Department of Medical Assistance Services TPL (continued) The MMIS User’s Guide contains screen shots and step by step instructions for entering new TPL policies, making changes and deleting. _atchs/dss-mnls/mmis_chapter_d_tpl.pdfhttp://dmasva.dmas.virginia.gov/Content _atchs/dss-mnls/mmis_chapter_d_tpl.pdf

9 Department of Medical Assistance Services TPL (continued) Always Enter Medicare Parts A & B coverage onto the TPL screens. Do NOT enter information regarding Medicare Advantage plans into the MMIS for Members who have both Medicare and a Medicare Advantage plan.

10 Department of Medical Assistance Services TPL Coverage

11 Department of Medical Assistance Services HIPP TPL LDSS Workers: –Cannot update HIPP data on TPL screens, even for closed cases. For changes or updates to HIPP policies contact the HIPP Unit: HIPP UNIT Assistance for LDSS with HIPP issues: (800)

12 Department of Medical Assistance Services Medicare Part A Qualified Disabled & Working Individuals QDWI (AC 055) is a covered group for the purpose of paying the beneficiary’s Medicare Part A premium. If an applicant does not have Medicare Part A premium, they are not entitled to QDWI. See Medicaid Manual M for QDWI eligibility policy. Medicare Part A coverage must be entered on the TPL screens even when there is not a premium.

13 Department of Medical Assistance Services Emergency & Dialysis Services If the applicant is found eligible and is certified for emergency services, eligibility exists only for the period of coverage certified by the LDSS (pregnancy only) or DMAS staff on the Emergency Medical Certification form. Additional requests for coverage of emergency services within 6 months do not require a new application. However, each request for coverage of an emergency service or treatment requires a new, separate certification.

14 Department of Medical Assistance Services Emergency & Dialysis Services (continued) DMAS will certify dialysis patients for up to a one year period of services without the need for a new Medicaid application. However, due to edits in MMIS, only one six-month certification period at a time can be entered. The worker must manually enter the second certification period of up to six months (as certified by DMAS) after the first period expires.

15 Department of Medical Assistance Services Emergency & Dialysis Services (continued) MMIS Enrollment: –Citizenship Status code, enter : A = Emergency services alien; D = Emergency services alien who receives dialysis Covered Dates –Coverage begin date, enter the begin date of the emergency service(s). –Covered end dates, enter the date when the alien's emergency service(s) ends.

16 Department of Medical Assistance Services Emergency & Dialysis Services (continued) Dialysis Eligibility Enrollment: –Citizenship Status Must = D –Must be enrolled as a closed period of coverage in six month segments. –Only one six month segment may be entered at a time.

17 Department of Medical Assistance Services EMC Inquiries Information regarding outstanding EMC’s can be obtained from: Jamene Cox, DMAS Phone: (804)

18 Department of Medical Assistance Services CCC - Addresses The Member Demographic screen must reflect the member’s physical address and FIPS code where the member resides, to include nursing home placements, to allow for: –Enrollment in health plan if member resides in one of the five designated regions. –Correct payment rates for region where member resides. –Contact from care manager for coordination of care needs.

19 Department of Medical Assistance Services CCC Addresses (cont.) Power of Attorney (POA) and authorized representative name and contact information must be entered on the members Comment Screen.

20 Department of Medical Assistance Services MMIS Duplicate Process If a possible duplicate is identified & LDSS does not believe the duplicate is the same person being added or changed a Duplicate Member Review request is submitted in the MMIS. Instructions for submitting a duplicate member review can be found in Chapter C of the MMIS User’s Guide: dss-mnls/Chapter_C_Final%2005_06_14.pdf dss-mnls/Chapter_C_Final%2005_06_14.pdf

21 Department of Medical Assistance Services MMIS Duplicate Process (continued) DMAS Enrollment Unit Staff will: “A” – Approve the review; if not a duplicate “D” – Deny the review; if a duplicate –Link the member ID numbers if it is a change/update transaction and the duplicate is the same person DMAS will never approve a duplicate with matching SSN’s.

22 Department of Medical Assistance Services MMIS Duplicate Process (continued) LDSS worker must check the duplicate review screen to see if DMAS action has been taken to approve or deny the request: –No notification is sent to the LDSS when action is taken. –If LDSS disagrees with denial, the Enrollment Inbox.

23 Department of Medical Assistance Services Overlays To prevent overlays in the MMIS: –Always file clear to determine if applicant already exists –Use care when selecting member in VaCMS

24 Department of Medical Assistance Services Overlays

25 Department of Medical Assistance Services Overlays (continued)

26 Department of Medical Assistance Services Overlays (continued) Place Holder

27 Department of Medical Assistance Services Help is an away… BUY IN UNIT Assistance with state Buy-In: (804) (804) HIPP UNIT Assistance for LDSS with HIPP issues: (800) LTC UNIT Assistance with level of care issues & related PP reports, admit dates: (804) TPL UNIT Assistance with TPL issues (804) MANAGED CARE HELPLINE Assistance for members (800) MEMBER HELPLINE: Assistance for members (804) CCC Unit Assistance with CCC issues.

28 Department of Medical Assistance Services Continued… Lois Brengel, Program Manager Eligibility & Enrollment Unit (804) Sarah Samick, Enrollment Supervisor Eligibility & Enrollment Unit (804) Cindy Olson, Eligibility Policy Manager Eligibility Policy Unit (804) Tiaa Lewis, HIPP Buy-In Manager HIPP & Buy-in Unit (804)

29 Department of Medical Assistance Services Thank you… Thank you for viewing this presentation. Continue to send questions and comments about this training or ideas for future trainings to: Eligibility and Enrollment issues should be sent to the Enrollment Inbox at Patient Pay enrollment questions or issues should be sent to the Patient Pay Inbox at

30 Department of Medical Assistance Services Thank You for All you do!!!!!