Medicaid

• Why doesn’t the total on my submission recap equal my edit report total?
• Why am I getting the message, “No Records To Be Created"?
• Why aren’t my clients showing up on the “active” list?
• How do I change the font on my Form 9 so that in the TCN number, the letter I doesn’t look like the number 1?
• How do I enter a new “individual” into the system?
• How do I terminate an “individual” from the system?
• Why doesn’t the individual show up under new funding?
• What does the message “Drive Not Ready” mean, when trying to import a Medicaid Remittance?
• What does “RTE 76 – Path not found” mean, when trying to create an output floppy to Medicaid?
• There are times when “Edit one day for a period” does not seem to delete the records. What can I do?
• Why doesn’t February 29th show on the calendar screen?
• If I change a screen name or sort name at the “Name/Address Maintenance” level, it does not seem to change on the screen when I go to the list of Medicaid Clients, or on either page of the Funding records. What should I do?
• How do I remove a record from the Name/Address table?
• I entered new Clients in the “Name/Address Maintenance,” but they do not show on the “Name/Address Clients” screen in the Medicaid application.
• MassHealth has returned a floppy they say they cannot read. How do I replace this submission?
• What place of service do I use for team meeting?
• How to Read a 997?
• Where do I store new MMIS RID number?

Why doesn’t the total on my submission recap equal my edit report total?
CHECK your dates. Always double check your date range when printing any report. If the date range is correct, look to see how many types of billing you are doing. The edit report will give you all information that is waiting to be billed, but the submission recaps are printed solely by type of billing. [TOP]

Why am I getting the message, “No records to be created”?
There is more than one possibility as to why you have received this message. Check your dates. It is possible that your admit date in your consumer file is after your billing period, or that your terminate date is before it. Next, check to see that all consumers are set up correctly in funding, check the beginning and ending dates here as well. [TOP]

Why aren’t my clients showing up on the “active” list?
As always, check your beginning and ending dates both in Name/Address and in funding. If these dates are correct, check your contracts. All contracts must have the following information set up correctly. Field 1A : mmars_num must be “00”. Field 1B : amen_num must be “00.” Field 2 : Inv_type must be an “S” not a “D.”[TOP]

How do I change the font on my Form 9 so that in the TCN number, the letter I doesn’t look like the number 1?
Go to the ETSACCT folder on your C: drive on your local machine or server. Open the REPORTS folder in ETSACCT. Then, double click on the report form9rb.rpt. Scroll to the bottom of the form 9 form and to the right, you should see the place holder for the TCN number as a string of XXXXXXXXX. With your mouse, highlight this string. Now change the font from Arial to New Times Roman. Make sure that you save your changes. [TOP]

How do I enter a new “Individual” into the system?
There are two places you need to go, to add a new “individual”:

1. Attendance Billing/ Medicaid: – Add/Edit Data and name address clients. You will have to again click the ADD button to obtain the long list and at that point, you will scroll down and find the name of the person you have just added and click EDIT. You will see the same first screen, but when you click save, you will have a second screen where you must input required fields.
2. funding-open sources: – ADD and input the required fields on three screens. [TOP]

How do I terminate an individual from the system?

There are two places to input a termination date:

1. Funding: Open Sources – There is an end date field on these two screens.
2. Add/Edit Data: – Name/Address Clients – There is a terminate date field on the second screen. [TOP]

Why doesn’t the individual show up under new funding?
When terminating someone under one funding source and keeping them active under another, only give them an end_date in the first screen of funding under the terminating contract. [TOP]

What does the message “Drive Not Ready” mean when trying to import a Medicaid Remittance?
There is no floppy in the “A” drive when trying to import a remittance file. Insert a disk in “A” and click to “ok” button. When the “Receipt Selection Form” appears you can choose any drive for the import. See Medicaid documentation, Section 7.B for changing drives and importing receipts. [TOP]

What does “RTE 76 – Path not found” mean when trying to create an output floppy to Medicaid?
There may be something wrong with your floppy drive or the “Submissions” folder is missing from your \etsacct\etsmed directory. If folder is missing copy submissions folder from your backup or create a new folder in your \etsacct\etsmed directory. See Medicaid documentation, Section 6.A for more information on creating billing. [TOP]

There are times when “Edit one day for a period” does not seem to delete the records. What can I do?
To delete records for a day you must type CAPITAL letters DD and press Enter. Typing lower case dd and/or clicking on “Update Records” with the mouse without pressing Enter on the capital DDs will not delete the records for a day. See Medicaid documentation, Section 5.E for more information about "Edit one day for a period."[TOP]

Why doesn’t February 29th show on the calendar screen after I create Attendance?
If you go into Add/Edit Originals and edit a consumer, it will appear on the Form 9 screen. If you need to delete that day, put your cursor on that line and click on “Delete this line.”[TOP]

If I change a screen name or sort name at the “Name/Address Maintenance” level, it has not changed on the screen when I go to the list of Medicaid Clients, or on either page of the Funding records. What should I do?
A name change in the name_addr table will not change existing records in other tables. You need to go into Access - 1) aratt.mdb/cc_base, 2) med.mdb/medcc and retype screen name and/or sort name. [TOP]

How do I remove a record from the Name/Address table?
We do not recommend removal of records from nam_addr. If this MUST be done contact ETS. [TOP]

I entered new Clients in the “Name/Address Maintenance”, but they do not show on the “Name/Address Clients” screen in the Medicaid application.
Clients added at the “Name/Address Maintenance” level have not been added to the cc_base table and therefore do not yet show on the lookup screen for “Name/Address Clients.” On the “Name/Address Clients” lookup screen click on “Add” and a message box willappear with the “This is the short list” message. Click on “ok.” The long list will appear. Choose the Client from the long list, click on “Edit,” and when you click on “Save” the cc_base screen will come up to be completed. See Medicaid documentation, Sections 4.A and 4.A1 for more information. [TOP]

MassHealth has returned a floppy they say they cannot read. How do I replace this submission?
On the hard drive where your data is stored, you will find the folder \etsacct\etsmed\submissions. In that folder you will find a file with the name med???.asc. The ??? represent the batch number of the run you are trying to replace. In Windows-Explorer copy this file to a new disk on drive “A:\”. On A:\ right click on the file. A drop down menu will appear. Click on “rename” and change the name of the file you have copied to the disk to simply “Hxxxxxxx.001.” xxxxxxx = Your Provider #. Relabel this disk with the original batch information, and send it with the submission recap to MassHealth. [TOP]

What place of service do I use for team meeting?
Use 11, but you have to manually change it on the Form 9 Screen. [TOP]

How to Read a 997?

The 997 Functional Acknowledgement is a document created automatically by MassHealth upon receipt of your Medicaid submission. The information it contains says whether or not the file went into processing to determine payments and denials. It is emailed to the address on file with MassHealth.

There are a few pieces of information in the 997 you need to know how to find. A typical 997 will look like this:

ISA*00* *00* *ZZ*DMA7384 ZZ1234567 …

GS*FA*DMA7384*1234567*20031217*083427*15*X*004010

The number *1234567* above is the Provider Number

ST*997*15001

AK1*HC*674 - Batch Number

AK2*837*0001

AK5*A

AK9*A*1*1*1

SE*6*15001

GE*1*15

IEA*1*000000069

You still need to find the AK5 segment, which tells you of Accept or Fail.

Open the file and then press the CTRL key and F at the same time (or File/Find). In the prompt screen type AK5 and press enter.

This will put you on the AK5 segment. To the right of the AK5, as you know, is either an R if rejected or an A if accepted. If it is an R, call the HIPAA Support line at 1-888-848-5068 to find out the specific reason why the file has been rejected.

THE AK5 SEGMENT:

The AK5 segment indicates whether the file passed validation or not. An ‘A’ signifies an approval and an ‘R’ is a rejection. The above example is a 997 response to a file that passed validation.

(A)pprovals – you do not need to do anything. You’re file format was fine and you will receive a remittance with payments and denials

(R)ejections – A typical 997 rejection file will resemble the following:

ISA*00* *00* *ZZ*DMA7384 ZZ1234567 …

GS*FA*DMA7384*1234567*20031205*150947*5*X*00410

ST*997*5001

AK1*HC*231

AK2*837*0001

AK3*LX*172**4

AK3*LX*175**4

AK3*LX*178**4AK3*LX*181**4

.

.

AK5*R*5

AK9*R*1*1*0

SE*1927*5001

GE*1*5

IEA&1*000000055

Notice the “AK5*R…” The AK3 segment gives the detail as to what is wrong with the submission file. The HIPAA Support Center (888-848-5068) can explain exactly what those lines read. When calling you need to know your Provider number and submission date of that batch.[TOP]

 

Where do I store new MMIS RID number?

In the cc base table there is a field "mis_num". You will find this field on the same page where you enter dob, sex and med_num.[TOP]