1. VA/DD-TCM Healthcare Claiming
Shawna Meyers| State Program Administrator Sr.
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

2. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
Fiscal Mentor Manual
SSIS Claiming Helpful Hints and Proofing Messages
Overview flow chart
Hints for each Healthcare Claim Category
Claims for clients in a MA Funded Facility are limited to 180 days for VA/DD-TCM, MH-TCM, and RTSC-TCM combined. The beginning of the 180 days is the Service Date of the first paid claim for VA/DD-TCM, MH-TCM, or RTSC-TCM. MMIS enforces this rule and no editing is done in SSIS.
Listing of Proof Messages for each claim category
Fiscal Reports and Descriptions
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

3. VA/DD-TCM Claiming Requirements
VA/DD-TCM claiming is done for Time Records meeting the VA/DD-TCM criteria for eligible clients.
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

4. Eligible Staff Activity Time Records
Services
592 – Child (<21) DD Non-Waiver Case Management
593 – Adult (21+) DD Non-Waiver Case Management
604 – Adult Protection Assessment and Investigation
607 – General Assessment
693 – General Case Management
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

5. Eligible Staff Activity Time Records (continued)
Activities
Client contact
Collateral Contact
Contact Status
Completed
Contact Method
Face to face
Phone
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

6. Supplemental Healthcare Eligibility
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

7. MMIS Recipient Information
Must be MA Eligible
Major Program – MA Eligible – Federally-Paid Medical Assistance
Eligibility Status must be
Active
Closed
Billable Contact Date must be within the Eligibility Start Date and Eligibility End Date
The client cannot be a Waiver/AC Recipient on the Billable Contact Date
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

8. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
Client Information
Client age is determined as of the Billable Contact Date
Client Age must be > = 18 on the Billable Contact Date
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

9. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
Diagnosis Codes
A billable diagnosis code is required to submit a claim. Diagnosis is determined in the following order:
Diagnosis code on a LTC or DD Screening document
Diagnosis code entered in SSIS on the Disability/Diagnosis/Substance screen
If there is not a billable Diagnosis, a default Diagnosis of Z60.9 is included on the claim
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

10. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
Additional Rules
Maximum of one VA/DD-TCM claim can be submitted per month per client.
All eligible Time Records in a month are linked to the claim.
A separate claim is created for each VA/DD-TCM eligible client listed in the Regarding section of the Time Record.
For a month in which both a Phone and Face to face contact occur, the Face to face contact is claimed even though it may occur after the Phone contact.
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

11. Additional Rules (continued)
A telephone claim is created for a month in which only a Phone contact occurred.
A Face to face contact must occur at least once every three months. This edit ignores Face to face claims that are Denied or To be denied.
The first claimable contact must be Face to Face.
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

12. VA/DD-TCM Claim Record
The healthcare claim includes:
HCPCS/Modifiers
Contact Method = Face to face
T2023 U1 – VA/DD-TCM, face to face
Contact Method = Phone
T2023 U1 U4 – VA/DD-TCM, telephone
Units = 1
First Service Date = Billable Contact Date
Last Service Date = Billable Contact Date
Diagnosis Code = Screening Diagnosis Code, SSIS Billable Diagnosis Code or Z60.9
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

13. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
Miscellaneous Notes
VA/DD-TCM may be provided concurrently with an investigation of maltreatment of a vulnerable adult. Documentation for both must be completed.
VA/DD-TCM cannot be provided to a person in an institution unless it is for the purposes of transitioning/relocating from the institution to the community. Institutions are defined as hospitals, nursing facilities (including Certified Boarding Care Facilities), and Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD).
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

14. Miscellaneous Notes Continued
VA/DD-TCM expenses are included as a part of a person's spenddown for MA eligibility. MMIS does this edit.
Contact during the month can be with the adult, the adult's legal representative, family member, or primary caregiver or other relevant person identified as necessary to the development/implementation of the service plan.
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

15. Additional Edits Not in SSIS
Eligibility
Client must be in need of service coordination to attain or maintain living in an integrated community setting and must be a vulnerable adult in need of adult protection as defined in statute.
County Practice
Counties develop criteria for identifying who is in need of case management/service coordination and keep a copy of those criteria on file in case of an appeal.
Counties can develop a tool to determine/document eligibility.
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

16. Generating a VA/DD-TCM Claim Batch
Select Claim Batch Search in the task panel.
Search to see if a draft batch exists. Based on your claims processes, enter as much or as little search criteria to determine if another batch exists for the time period you are working with.
To create a new healthcare claim batch click the Action menu and select New Claim Batch.
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

17. Generating a VA/DD-TCM Claim Batch continued
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

18. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
VA/DD-TCM - CLAIM TAB
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

19. VA/DD-TCM – Time Proofing Tab
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

20. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
2003 – No VA/DD-TCM Staff Qualifications for the worker on the activity date
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

21. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
2004 – No Staff-provided Rate for the HCPCS/Modifiers on the activity date
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

22. 2014 – County of Service not in the region
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

23. 2203 – First claimable contact must be “Face to face”
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

24. 2204 – “Face to face” contact required at least once every 3 months
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

25. 2202 – “Contact Status” (Attempted) is not claimable
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

26. 2201 – Age (17) on the service date must be 18 or over
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

27. 2017 – One or more claims already exist during the service dates
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

28. 2010 – No Eligibility Span exists for the service dates
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

29. 2011 – The Major Program is not valid for VA/DD-TCM
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

30. 2021 – The client has no Healthcare Eligibility from MMIS
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

31. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
2015 – No VA/DD-TCM Supplemental Eligibility Exists for the service dates
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

32. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
1018 – No PMI #
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

33. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
107 – Est. date of birth
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

34. 2008 – A Do Not Claim Determination is in effect on the service dates
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

35. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
2018 – “Qualified” = “No” on the VA/DD-TCM Staff Qualifications for the worker on the activity date
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

36. 2051 – An Exclusion for Healthcare Claiming exists
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

37. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
 Submitting the batch
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

38. Updates to the Submitted Batch
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

39. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
VA/DD-TCM Reports
In addition to the general Healthcare Claim Reports that cover all claim categories there is one General Reports specific to VA/DD-TCM, the VA/DD-TCM Eligibility Report. This report is available from:
Tools>General Reports> Healthcare Eligibility
Searches/Logs>Healthcare Claiming>Healthcare Eligibility Reporting
(Treeview) Healthcare Claiming> Healthcare Eligibility Reporting
The next slide will show you what the screen looks like
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

40. VA/DD-TCM Reports continued
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

41. VA/DD-TCM Eligibility Report Example
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

42. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
Questions
VA/DD-TCM Healthcare Claiming | mn.gov/dhs

43. VA/DD-TCM Healthcare Claiming | mn.gov/dhs
Thank You!
Shawna Meyers
SSIS Fiscal Mentor Meeting –
VA/DD-TCM Healthcare Claiming | mn.gov/dhs