MMIS WebEx Training

http://www.dmas.virginia.gov/ 1

Department of Medical Assistance Services

Department of Medical Assistance Services – Eligibility and Enrollment Unit

March 2013

http://www.dmas.virginia.gov 1


MMIS WebEx Training



Agenda• MMIS User’s Guide• Managed Care Enrollment• Certain Newborn Enrollment• Enrolling NB’s of FC Children• Social Security Numbers• Medicare Buy-In• Cancel Reason “001”



MMIS User’s Guide• Chapter F of the MMIS User’s Guide has

been updated to reflect:– Correct entry of member’s address for MCO

assignment– Where letters and cards are sent; case address

vs. demographic address– When letters are mailed for MCO

pre-assignmentDMAS Eligibility and Enrollment Unit Webpage:http://dmasva.dmas.virginia.gov/content_pgs/dss-elgb_enrl.aspx

http://dmasva.dmas.virginia.gov/content_pgs/dss-elgb_enrl.aspx



Managed Care Enrollment

• Eligible foster care/adoption assistance members in the Tidewater and Central regions will be enrolled in a managed care organization (MCO) effective 7/1/13



FC/AA Member Pre-assignment• Preassignment to an MCO will occur on the May

18, 2013 managed care run• Preassignment letters will be mailed by the end

of May• Individuals have until June 18 to call to make

their selection• No call by June 18 = enrollment in MCO listed in

preassignment letter effective 7/1• Obtain services through fee-for-service (regular

Medicaid) until MCO is effective 7/1/13



FC/AA Exclusions from Managed Care• Children who are hospitalized at time of

enrollment;• Children placed in a psychiatric residential

treatment facility (PRTF); • Children who are also covered under

parent’s private insurance; and• Undocumented minors



Enrollment cut-off dateClients must call by 18th of the month (or

last business day before if 18th is on a weekend/holiday)

Changes will be effective 1st of following month

Clients call after 18th, change is delayed another month

Example: call by June 18, change effective July 1. Call after June 18 and before July 18, change effective August 1.

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Changing MCOs• 90 days from the effective date to contact

the Managed Care Helpline to make a change

• After 90 days, changes are not allowed until annual open enrollment unless member shows good cause

• Good cause requests may be made by calling the Managed Care Helpline

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http://www.dmas.virginia.gov



Annual Open Enrollment• Notified by mail• Members have 60 days to change MCO if

they choose• If they do not want to change, no action is

needed• Open enrollment dates vary by region.

Visit http://www.dmas.virginia.gov/Content_atchs/mc/mc-opn_enrl.pdf for specific dates

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http://www.dmas.virginia.gov/Content_atchs/mc/mc-opn_enrl.pdf

http://www.dmas.virginia.gov/Content_atchs/mc/mc-opn_enrl.pdf



Managed Care Helpline• The Managed Care Helpline is available for

members to call with questions about managed care, providers, and for assistance in choosing/changing their MCO.

1-800-643-2273TDD: 1-800-817-6608 8:30 am – 6:00 pm

Monday through Friday

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MCO Customer Service

Amerigroup 1-800-600-4441Anthem HealthKeepers 1-800-901-0020CareNet-Southern Health 1-800-279-

1878MajestaCare 1-866-996-9140Optima Family Care 1-800-881-

2166Virginia Premier 1-888-338-4579

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Certain Newborns - Tips• When enrolling certain newborns (NB) it is

important to remember to:– Enter the mother’s ID number on the

demographic screen– Enroll with AC 093– Citizenship & Identity verification should =

“NB” to exempt the NB from the citizenship & identity verification requirement.

– Ensure the eligibility begins on the NB DOB – regardless of the application date!



NB’s Born to FC Children

• A child born to a IV-E FC child is enrolled in AC 076 when the mother’s IV-E payment includes an allocation for the child.

• If the allocation is discontinued and/or child leaves the care of the FC child the newborn child’s AC 076 coverage should be cancelled and reinstated in AC 093 until he turns age one.



NB’s Born to FC Children

• A child who is born to a non-IV-E FC child and who does not receive a IV-E allocation is enrolled as a certain newborn (AC 093) until the child turns age one.

• Neither an application for Medicaid nor proof of application for a SSN is required for a certain newborn until the child turns age one.



SSN Requirements• To meet Medicaid eligibility an individual:

– Must provide a SSN or provide proof of application for a SSN, unless the individual:• Is an alien only eligible only for emergency services• Is a child under age one born to a Medicaid mother

• Broadcast 6977:– Pseudo SSN’s must begin with a “999” prefix– “888” prefix is no longer valid – it is now in use

by the SSA



Name & SSN Entry in the MMIS

• The name entered in the MMIS must match the name on the Social Security card or SSA records verifications.

• MMIS sends this information to SSA for the Medicare Buy-In or the citizenship and identity match



SSN Requirement Deadline

• The verified SSN must be entered into ADAPT and the MMIS by renewal

• If not provided by renewal and the problem is not an SSA administrative problem, Medicaid coverage should be cancelled



SSN Verification

• MMIS sends identifying data to the SSA for verification on the 21st of the month

• The monthly SSN & Citizenship Update Report should be reviewed for rejected member data such as name, SSN, or DOB

• Any member with a SSN Status of “not verified” must have the discrepancy resolved



Medicare Buy-In

Medicare Buy-In benefits were created by Congress to help low-income Medicare beneficiaries by

paying their Medicare premium. These programs are known as:

– QMB (Qualified Medicare Beneficiaries) – SLMB (Specified Low Income Medicare Beneficiary)– QI-1 (Qualified Individuals 1).

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Medicare• The Medicare Program provides Hospital

Insurance or Medicare Part A coverage, and Supplementary Medical Insurance, known as Medicare Part B coverage.

• Coverage for Medicare Part A is free for people age 65 or older who have insured status under Social Security or Railroad Retirement.



Medicare Buy-In Overview• The Statutory Authority for the Buy-In program is

section 1843 of the Social Security Act.• The procedure by which a Medicaid eligible

individual, who is also eligible for Medicare Part B, has their premium paid for by the State.

• Transfers some medical costs for this population from the Title XIX Medicaid program to the Title XVIII Medicare program.

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Medicare Part A• An individual must be eligible for Medicare Part A

in order to be included in a Part A Buy-In agreement or group payer arrangement. Part A eligibility can be obtained by those:

– Age 65 or over who are U.S. residents and citizens or aliens lawfully admitted for permanent residence who have resided in the U.S. five years prior to application for enrollment

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Medicare Part A• In some instances the state will pay for the cost

of enrollee’s Medicare Part A if one is being charged.

• Beneficiaries who may have a reduced Part A premium cost:

– Individuals who have 30 to 39 qualified work quarters

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Medicare Part B• An individual must be eligible for Medicare Part B

in order to receive Buy-In benefits. Part B eligibility can be obtained by those:

– Age 65 or over who have Medicare Part A– Age 65 or over who are U.S. residents and citizens or aliens

lawfully admitted who have resided in the U.S. five years prior to application for enrollment

– Under age 65 and eligible for Medicare Part A due to receipt of Title II or Railroad disability benefits for more than 24 months

– Medicare Part A recipients with chronic renal disease (dialysis patients)

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Medicare ID Numbers• An individual’s Medicare number always begins

with a nine digit number and ends with either one alpha character or a alpha number characters such as;– 123-45-6789A or;– 123-45-6789B1

• Railroad Retirement Board (RRB) Medicare numbers contains an alpha prefix and a six or nine digit number such as;– A123456 or;– WCA123456789

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Medicare• The Social Security Administration (SSA)

determines Medicare eligibility and maintains the Master Beneficiary Record (MBR).

• The Centers for Medicare and Medicaid Services (CMS) manages the Medicare program. SSA sends information to CMS regarding Medicare eligibility and CMS maintains a master file of all individuals eligible for Medicare.

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Buy-In Eligibility

• An individual can refuse Medicare Part B coverage due to the cost of the premiums. If found Medicaid eligible, they do not have to wait for the open enrollment period for Part B. Buy-In will begin immediately or within 2 months.

• MN non-QMB AC’s have a 2-month waiting period from the Medicaid begin date until buy-in begins. Non-QMB members are not eligible for Part A Buy-In.

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Buy-In Eligibility

• The following Medicaid AC’s are not eligible for Medicare Buy-In:– AC 005, 006, 007, 008, and 009 (FAMIS)– AC 066 (Breast and Cervical Cancer Treatment and

Prevention)– AC 080 (Plan First)– AC 055 (Qualified Disabled Working Individual)

• AC 055 (Qualified Disabled Working Individual) is only eligible for Medicare Part A Buy-In

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Buy-In Eligibility• Cut-off falls on the 23rd of each month • On the 24th of each month Buy-In files are

forwarded to CMS to:– Establish Buy-In for new Medicaid members– End Buy-In for cancelled Medicaid members– Correct existing information in the CMS files

• CMS processes the file by the end of the month and sends a response file to DMAS.

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Buy-In Eligibility• The Buy-In Unit analyzes reports to make any

needed corrections to the Buy-In process.

• Buy-In analysts assists LDSS offices, SSA staff, CMS, providers and members with premium issues or claims resolution.

• Medicaid cancellations are submitted to CMS on the month following cancellation to prevent erroneous premium deductions when eligibility is reinstated.



Buy-In Unit Contact Information• Buy-In Inbox:

[email protected]

• Staff Contact Information:

– Rhonda Bowers (804) 371-8888– Sherrill Taylor (804) 786-7414– Phoebe Adams (804) 371-2375

mailto:[email protected]



Cancel Reason “001”• MMIS Cancel Reason Code “001” is only used to

close eligibility for deceased members; not to be confused with ADAPT change reason “001”.

• If Cancel Reason “001” is mistakenly used send an email to the Enrollment Inbox for correction by DMAS staff.

• Screen help in the MMIS provides a complete list of cancel reason codes used in the MMIS.



Thank you…Thank you for viewing this presentation. Continue

to send questions and comments about this training or ideas for future trainings to:

[email protected]. Eligibility and Enrollment issues should be sent to

the Enrollment Inbox at [email protected]

Patient pay enrollment questions or issues should be to the Patient Pay Inbox at [email protected]




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