Purpose of this FAQ What’s the purpose of this FAQ? Conversion and Go-Live, IS 2.0 I've heard that you're going to convert all archived claims. But what's going to happen with those duplicate claims that were accidentally generated by the IS? We had some duplicate claims, and we were told to just archive the duplicates and ignore them. Will they all of a sudden show up as unclaimed services? What about those new fields: Hispanic Origin and American Native Tribe? And also, Evidence Based Practice? Since there's no data in those fields for old claims, what will happen when they are converted? Why did you delay the Go Live date? PATS will be down that week of conversion (Nov. 17-27), so what do we do about prescriptions for our clients? What if we don't have their PATS card number, or their DMH ID#? Forms Where are the new Forms? Why are there three different Daily Log Forms? Have the Forms changed since training started? We use the NCR forms instead of the Daily Log...what should we do? Client Information If you select Hispanic for Ethnicity and you don’t know the Origin is there an option to select unknown? Also for American Native, you know they are American Native, but you don’t know the tribe, is there an option to select unknown? Can you leave them blank if your client is Hispanic or American Native? My supervisor saw the new daily service log and she does not understand what evidenced based practice is, and we in the IS dept attended the IS 2.0 training and the trainer explained that is for the clinicians to utilize. Is there any information that has been released to further explain what evidenced based practice is for the clinicians? Duplicate Clients If an individual has multiple IS numbers, which number should be used for the current episode? Will the processing and changing of UMDAP dates change in IS 2.0? How do I get information about Evidence Based Practices? Eligibility Will the IS still automatically prompt me to do an Eligibility Check when I enter the first service of the month? All of my Eligibility Checks just disappeared! What happened? Services Screen What's the difference between the CLAIM button on the bottom of the screen, and the "Claim" on the Options menu (left side of screen)? EDI What's EDI, anyways? Can you clarify which EDI claims will display in the IS 2.0 services and claims screens? Claims Given the fact that Denied Claims will be converted out of the archive, will the IS 010 still be useful? We use archive to HIDE the Denied Claims we've worked. Plans If we run out of funds for our main plan (say it's AB3632), will Finance automatically pay us from CGF, or do we need to change the plan? SFPR How can I clear the SFPR if it was originally entered at the provider location level, not the individual provider level? That level no longer exists because Provider Context is no longer that specific...it's no longer an option. Full Service Partnership Is the DMH ID box on the Contact Information screen only for CHILDREN, or should you use it for other family members? Reports In reports there is an option to "View Claims Visible on Admin," but since there is no Administrative side anymore, what should I do with that? Training Are there more trainings planned?

 

Purpose of this FAQ

 

What’s the purpose of this FAQ?

 

This FAQ was established to collect and answer questions about the new IS 2.0 during the trainings. In many cases, trainers don’t have the information to answer questions. We’re collecting those questions, finding the answers, and posting them here.

 

Conversion and Go-Live, IS 2.0

I've heard that you're going to convert all archived claims. But what's going to happen with those duplicate claims that were accidentally generated by the IS? We had some duplicate claims, and we were told to just archive the duplicates and ignore them. Will they all of a sudden show up as unclaimed services?

 

Those false or duplicate claims will not be brought back as services. The problem with those claims is that inside the system they don't link back to an actual service, so they can't be converted into unclaimed service. Sierra has flagged those claims as "abandoned," and will not convert them. A key thing to remember is that everything is now keyed off of the service, in other words there may be MANY denials and resubmits and voids connected to a service, but they will all be tucked away on the Claim Cycle screen (that's the one you see when you click on the "Resubmit" icon on the Services screen.

 

Although duplicate claims will not be converted, there are claims that users archived because they just wanted to hide them. These claims might suddenly appear and cause some confusion. If you ever used archive to "sweep stuff under the rug," those claims might reappear. Remember: you can now VOID a DENIED CLAIM!

 

What about those new fields: Hispanic Origin and American Native Tribe? And also, Evidence Based Practice? Since there's no data in those fields for old claims, what will happen when they are converted?

 

Remember the "Veteran" field? When we rolled out IS 1.0 you had to enter the Veteran status on your old clients. Same thing here: if you go back to the Client Informtation screen you might need to enter that information...or the Evidence Based Practice information on the Services Screen.

 

Why did you delay the Go Live date?

 

The DMH CIOB decided to push the date back because we did not get a response from the state of California in a timely manner. DMH is determined to see several substantial "round trips" of IS transactions before we switch to the new system.

 

PATS will be down that week of conversion (Nov. 17-27), so what do we do about prescriptions for our clients?

 

As with the last conversion period during the transition from MHMIS to IS 1.0, providers will be required to use paper forms to write prescriptions, and will need to enter that information in the IS 2.0 after 11/27/2006. Check out the Memo from Pharmacy Chief Wayland Chan

 

What if we don't have their PATS card number, or their DMH ID#?

DMH ID numbers will not be issued during the time the Integrated System is down. While it is true that a client may be known to the DMH system (meaning the client has a DMH ID number), you will be unable to verify that number because the system will be down. During the system downtime, our DMH contracted pharmacies will not require a DMH ID number, nor will they require a prescription (PATS) card to issue a prescription. The pharmacy procedures indicate you should write the DMH ID number if the client is known to your organization (this number should be in the medical record at the clinic).

 

If the client is unknown to your organization, since you will be unable to perform a client search you should leave the DMH ID number field blank on the PATS prescription. The same is true for the PATS card number: leave this field blank if the client is not known to your organization.

 

When the system comes up on Monday, November 27th, you can perform client searches on these clients as well as issue new PATS cards if necessary. Hold the new cards at the clinic until the client comes in for their next visit.

 

 

Forms

 

Where are the new Forms?

 

Forms are on the [http://dmh.lacounty.info/hipaa/index.html\IS Website] under your provider type. Contractor Forms are here, Directly Operated Forms are here. There's a Bulletin about IS 2.0 Forms that provides more information.

 

Why are there three different Daily Log Forms?

 

Version One is for services with one (or no) Additional Staff, Version Two has spaces for two staff, and Version Three has spaces for recording plan information in the far right column.

 

Have the Forms changed since training started?

 

Yes, there have been changes made during October AND November of 2006. For example, the Daily Logs now include Evidence Based Practices AND Service Strategies. In fact there is a new List of Evidence-Based Practices/Service Strategies on the Forms page. The COS Codes Sheet has changed too, and there have been minor changes to other forms.

 

We use the NCR forms instead of the Daily Log...what should we do?

Those NCR forms are being redesigned by our Quality Assurance team. They should be available soon.

 

Client Information

 

If you select Hispanic for Ethnicity and you don’t know the Origin is there an option to select unknown? Also for American Native, you know they are American Native, but you don’t know the tribe, is there an option to select unknown? Can you leave them blank if your client is Hispanic or American Native?

 

If your client is Hispanic, you MUST enter an Origin. If you client is American Native, you MUST enter a Tribe. "Other" is an option in both cases, but "Unknown" is not since the State of California doesn't recognize that as an answer. Blanks here will cause an error.

 

My supervisor saw the new daily service log and she does not understand what evidenced based practice is, and we in the IS dept attended the IS 2.0 training and the trainer explained that is for the clinicians to utilize. Is there any information that has been released to further explain what evidenced based practice is for the clinicians?

 

DMH Director Dr. Marvin Southard sent out a packet concerning this around October 26, 2006. There is also an IS News Bulletin about it, please read Bulletin #34. Take a look at the IS 2.0 Page...there are a whole series of documents there to help you with EBP and Service Strategies. Here's the IS 2.0 Page.

 

Duplicate Clients

 

If an individual has multiple IS numbers, which number should be used for the current episode?

You need to pick the oldest MIS #, unless a more recent one is full of open episodes. If there are duplicate MIS #'s that have closed episodes in them, call Help Desk and ask them to Cross Reference (meaning collapse) those episodes.

 

 

Will the processing and changing of UMDAP dates change in IS 2.0?

No. As with many other things in the IS this will remain the same.

 

 

How do I get information about Evidence Based Practices?

Take a look at the IS 2.0 Page...there are a whole series of documents there to help you with EBP and Service Strategies. Here's the IS 2.0 Page.

 

Eligibility

 

Will the IS still automatically prompt me to do an Eligibility Check when I enter the first service of the month?

 

No. EC's are for Medi-Cal only, and there's nothing automatic about them anymore. You can easily see if an EC was done by clicking on the M-Cal Benefits Tab, or by looking at the Services inside the Episode. Many clinics do EC's at the beginning of the month as a separate process, and of course since they're based on Billing Provider not Service Location or Rendering Provider, someone else might have already done the EC for you!

 

All of my Eligibility Checks just disappeared! What happened?

 

Someone deleted the Medi-Cal CIN #. In the IS 2.0 that number is what connects the client to the eligibilty checks. You can bring them back by going to the Financial tab and adding the CIN # again.

 

Services Screen

 

What's the difference between the CLAIM button on the bottom of the screen, and the "Claim" on the Options menu (left side of screen)?

 

The CLAIM button at the bottom of the screen is an action button that will start a claim, the choice under "Options" is a navigation link to a claim that has already been created. If you haven't created a claim alread and you click the navigation link, you will get an error message: "You need to add service first." Please click the CLAIM button to create a claim!

 

EDI

 

What's EDI, anyways?

 

It stands for Electronic Data Interchange. Some providers enter data into their OWN systems, and then send it to the IS. That's EDI in a nutshell.

 

Can you clarify which EDI claims will display in the IS 2.0 services and claims screens?

 

If the EDI claim is denied by IS Rules or CICS, then it will not be displayed in the service or claim screen. The EDI providers will still need to use the reports to see these denied claims.

 

If the EDI claim is denied by Medi-Cal or Medicare, then it will display on the service and claim screen. In addition, if the user decides to Void or Resubmit the claim, these will also show on the screens and the user will be able to drill down just like a regular DDE claim or service.

 

If the EDI claim is pending, forwarded, approved it will be shown on the services and claims screens.

 

Claims

 

Given the fact that Denied Claims will be converted out of the archive, will the IS 010 still be useful? We use archive to HIDE the Denied Claims we've worked.

The IS 010 will still function in 2.0, and it will help you identify Denials throughout your clinic, but the new Claim Status screen will give you information about denials on the spot. Next time you see a red $, click on it and you will see the deny reason right on the screen.

 

Plans

 

If we run out of funds for our main plan (say it's AB3632), will Finance automatically pay us from CGF, or do we need to change the plan?

 

If a provider has availble CGF, Finance will be able to make an adjustment once all claims for that fiscal year are in.

 

SFPR

 

 

How can I clear the SFPR if it was originally entered at the provider location level, not the individual provider level? That level no longer exists because Provider Context is no longer that specific...it's no longer an option.

This should not be an issue.

 

Full Service Partnership

 

Is the DMH ID box on the Contact Information screen only for CHILDREN, or should you use it for other family members?

 

At this point, that box is only for Children of clients enrolled in an FSP.

 

Reports

 

In reports there is an option to "View Claims Visible on Admin," but since there is no Administrative side anymore, what should I do with that?

 

You can ignore that setting. With the conversion of claims out of Admin, the flag will no longer have an effect.

 

Training

 

Are there more trainings planned?

Yes, we are planning more trainings. We have already started working on "Basic IS" for any new employees...and we are continuing our hands on and other trainings for IS 2.0. Here's the IS 2.0 Page in case you want to see what's going on there. Soon, we'll move trainings back to the "Getting IS Training" pages on the IS Website...that's where you can find our regular "Basic IS" courses.