Illinois Department of Human Services Division of Mental

Illinois Department of Human Services / Division of Mental Health and Illinois Mental Health Collaborative Present Introduction To Intelligence. Connect and Reporting December 2008

Agenda l l l Introductions Access Intelligence. Connect Claims Reports – – l l l 2 Review Available Reports/Data Set Review Upcoming Reports Questions Review Upcoming Registration Reports Questions

Introductions Kathy Melia, Collaborative VP Operations Lisa Laplante, Collaborative Claims Director Cathy Doran, Collaborative EDI Help Desk Manager Karen Vendetti, Collaborative Eligibility Director Mike Wagner, Collaborative Claims Manager Jason Martin, Collaborative Reporting Analyst 3

Reports and Data Sets l HFS Eligibility data and Claims data is downloaded to the warehouse on a weekly basis: – l Registration data is updated daily and includes data submitted the previous day – l l l 4 Updated information becomes available on Mondays and includes data submitted through the previous Friday by 6 pm Online and Batch Only registrations entered into the Collaborative’s system are available for reporting Reports are delivered in a “PDF” format (Portable Document Format) Data sets are created in the Microsoft Excel format and can be downloaded to a local desktop for analysis and ad-hoc reporting

Overview: Intelligence. Connect provides a method for providers or their designated representatives to generate reports regarding claims or registrations for Illinois consumers. – Access Intelligence. Connect via link from Provider. Connect – Enter data into a series of screens or windows with drop down boxes or fields to set report parameters – All data comes from Collaborative’s Data Warehouse Claims, HFS Eligibility and Registration data used for these reports is entered into, or generated by, the adjudication processes from the various Collaborative systems and then downloaded into our data warehouse. 5

Claim Reports Excel Data Set Includes all claims detail for finalized claims EDI 837 P Management Reports – in pdf format Monitor claim volumes and staff productivity by submission date, submitter ID, or submission # Claim Status – in pdf format Monitor claim results by those paid, denied and still in process 6

Access Claims Reports Log-on Provider. Connect via the Illinois Mental Health Collaborative Website www. illinoismentalhealthcollaborative. com l 7

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837 P and/or DCS Denied Claim Lines by Submission Date 17 l Shows denied claim lines for a date range, regardless of the manner of claim submission (batch or direct) l Report shows claim line detail of those claims finalized to deny including primary reason for denial l EOP message shown is the message received on Provider Summary Voucher. More generic HIPAA compliant description on 835

Claims Report Name Description of Report Parameters for entry Fields Generated ILL Report of Denied Claim Lines by Submission Date A detailed pdf report Submission Start Date Submission End Date Batch Submission # Provider (All "*" or Specific) Claim #, Line, RIN, Provider #, Service Date, Service Code, Claim Amt. , Denial Code, EOP Denial Description, Line Item Control #, Submitted Program Code, Staff ID, Place of Service, Service Location, NPI #, Consumer Name ILL Report of Denied Claim Lines by Submission Date – Fund Source ILL Report of Denied Claim Lines by Submission Date – Consumer Name 18

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Report of Staff ID Activity Submitted by Service Date At each service location a summary of total services provided by each staff member, including total units and charges on a specified service date 31

Claims Reports 32 Report Name Description of Report Parameters for entry Fields Generated ILL Report of Staff ID Activity Submitted by Service Date A Summary pdf report Submission Start Date Submission End Date Staff ID (All "*" or Specific) Provider (All "*" or Specific) Service Location Submitter ID Staff ID Place of Service Code Units Claim Amt.

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Report of Staff ID Activity Submitted by Service Date-Sample Report ILL Report of Staff ID Activity Submitted by Service Date Submitter ID 123456 Service Start Date Staff ID POS Code Date of Service Charges Service Location : XYZ Street 11 09/15/08 Service End Date Service & Modifiers Total Units 09/16/08 Total 00005 9/15/2008 H 0032 HO H 0004 H 0032 HO HQ HO H 0004 H 0032 H 2015 HO HO HO H 2017 T 1016 HQ TG H 2017 HQ 200 10 00 $ 1, 685. 25 $ 200. 00 8 $ 144. 16 16 16 4 $ 288. 32 $ 96. 16 $ 72. 08 10 4 9 $180. 20 $ 72. 08 $162. 18 HO HN 70 1 $ 420. 70 $ 16. 65 HO 72 $ 432. 72 9/16/2008 HO 00008 9/16/2008 000000010 9/15/2008 9/16/2008 Service Location XYZ Street 43 Approved Units, Charges Denied Units, Charges In Process Units, Charges

Excel Data Set Claim Detail –Excel format data set of finalized claims that can be saved to Provider’s desktop and sorted according to provider’s preference. Select by either received (submission) date, service date, or paid date. A specific date or date range is required to limit data set size. Additional selection criteria: l A specific consumer or all consumers, l A specific service code or all service codes l l 44 Data Set is limited by Excel’s limitations. Providers need to plan timing and approach to extracting data

Claim Data Set 45 Data Set Description of Data Set Parameters for entry ILL Claims Detail Data Set A detailed Excel data set for claims that have been finalized through posting Provider (All "*" or Specific) Beginning Received/Service/Paid Date Ending Received/Service/Paid Date Consumer # Service Code

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Data Set 55

56 Claim # Claim number assigned by the Collaborative Vendor # Collaborative assigned identification for provider service location RIN Consumer ID # Line # the line number within the claim DOS Date of Service Code HCPCS or CPT code Mod 1, Mod 2, Mod 3, Mod 4 Up to 4 modifiers as submitted by provider Dx Code 1, Dx Code 2, Dx Code 3 Up to 3 diagnosis codes, as submitted by provider Charge the Billed amount for this service code Allowed The fee schedule allowed amount Prepaid Amt The amount approved to apply against pre-payment amount Paid Amt If dollars are paid, the amount paid here Paid Date The date the claim went through a payment cycle Remark Code 1, Remark Code 2, Remark Code 3, Remark Code 4 The messages that will appear on Provider Voucher to explain a denial Line Item Control # Optional control number submitted by provider

57 Patient Account# Optional patient identifier as submitted by provider Activity Code The W code that accompanied service code S 9986 in the line note Duration Length of time the session lasted as submitted by provider in line note Start Time Start time of the session as submitted by provider in line note Delivery Mode Either face to face (F), video (V) or telephonic (T) as submitted by provider in line note Submitted Program Code submitted on the claim Adjudicated Program Code that was assigned to the service during claims adjudication Staff Qualification Indicator From the Claim Note OHI Paid If there is other insurance coverage, the amount paid by that coverage Subcontractor NPI The NPI of the entity to which services were subcontracted Subcontractor FEIN The Federal Employer Identification Number of the entity to which services were subcontracted Group ID For group based services the group ID as assigned by the provider and sent in the line note # clients in Group For group based services the number of clients in the group as sent by the provider in line notes # staff in group For group based services the number of staff in the group as sent by the provider in line notes Staff ID Optional Staff ID as assigned by provider in line notes

Upcoming Claims Reports EDI 837 P Management Reports • Report of EDI Batch Claims by Batch Submission # -Track claims volume and status by EDI batch submission number. Detail and summary. • Report of EDI Batch Claims by Batch Submission Date - Track claims and submission volume submitted on a specified date or date range. This report may span multiple submission numbers. Detail and summary. • Report of EDI Batch Claims Submitted by Submitter ID - Allows a provider to see total # of batches submitted by one or multiple submitter IDs for a selected submission date or date range. Summary report. Claim Status Reports – Summary and Detail • Report of Claims in Process by Submission Date -shows all claims still in process (not finalized) for specified submission dates. • Report of Approved Claims by Submission Date - Report of finalized claim lines with allowed amounts greater than zero for a date range, regardless of the manner of claim submission 58

Questions and Answers 59

Registration Reports

Consumer Registrations that Expire within a specified number of days Report Name Description of Report Parameters for entry Fields Generated l. IL A Summary pdf report of consumer registrations that are expiring within a specified number of days Number of days Submitter ID, RIN, Client ID, Last Name, first Name, Date of Birth, Gender, Registration Start date, Program Code, Expiration Date, Expiration Indicator Consumer Expiring Registrations by Submitter/RIN l. IL Consumer Expiring Registrations by Submitter/Client ID l. IL Consumer Expiring Registrations by RIN l. IL Consumer Expiring Registrations by Client ID l. IL Consumer Expiring Registrations by Expiration Date l. IL Consumer Expiring Registrations by Last Name 61

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Consumer Registrations Entered between Begin Date and End Date Report Name Description of Report Parameters for entry Fields Generated l. Il A Summary pdf report of consumer registrations that were entered with a specified time frame Date Range – Begin date and End date (up through the day before) Submitter ID, RIN, Client ID, Last Name, first Name, Date of Birth, Gender, Registration Start date, Program Code, Closure Date, Entered Date Consumer Registrations Entered by Date Range by Submitter ID/RIN l. Il Consumer Registrations Entered by Date Range by Submitter ID/Client ID l. Il Consumer Registrations Entered by Date Range by RIN l. Il Consumer Registrations Entered by Date Range by Client ID l. Il Consumer Registrations Entered by Date Range by Date Entered l. Il Consumer Registrations Entered by Date Range by Last Name 69

Consumer Registrations Entered between Begin Date and End Date – Sample Report Consumer Registrations Entered between 7/1/2008 and 7/30/2008 for provider 123456789 Submitter ID 999999 RIN 123456789 231234535 Client ID 000001 000612 Last Name Doe Jones First Name John Eva Date of Birth 01/01/1990 10/09/1960 Gender M F Start Date Program 07/01/2008 ABC Closure Date 07/15/2008 Entered Date 07/30/2008 121 350 575 07/15/2008 07/30/2008 07/01/2008 ABC 350 575 07/05/2008 Total for Submitter ID 999999 – 2 ---------------------------------------------------Page Break-----------------------------------------------Submitter ID RIN Client ID Last Name 999999 IL 123456321 000550 Green Total for Submitter ID 999999 IL – 1 Total All Submitter IDs - 3 70 First Name Sam Date of Birth 01/01/1995 Gender M Start Date Program 07/15/2008 ABC 350 575 Closure Date Entered Date 07/23/2008

Consumer Registrations that have Expired Report Name Description of Report Parameters for entry Fields Generated l. Il A Summary pdf report of consumer registrations that have expired as of the day the report was run None Submitter ID, RIN, Client ID, Last Name, first Name, Date of Birth, Gender, Registration Start date, Program Code, Expiration Date, Expiration Indicator, # days Expired Registrations by Submitter ID/RIN l. Il Expired Registrations by Submitter ID/Client ID l. Il Expired Registrations by RIN l. Il Expired Registrations by client ID l. Il Expired Registrations by Expiration Date l. Il Expired Registrations by Last Name 71

Consumer Registrations that have Expired – Sample Report requested on 2/1/2009 Consumer Registrations that have Expired for Provider 123456789 Submitter ID RIN Client ID Last Name 999999 123456789 000001 Doe 999999 231234535 000612 Jones First Name John Eva Date of Birth Gender Start Date Program Expiration Date Exp Ind 01/01/1990 M 07/0120/08 ABC 121 350 575 12/31/2008 10/09/1960 F 07/01/2008 ABC 350 575 12/15/2008 #/Days 31 31 SASS 45 45 45 Total for Submitter ID 999999 – 2 --------------------------------------------Page Break---------------------------------------Submitter ID RIN Client ID Last Name 999999 IL 123456321 000550 Green Total for Submitter ID 999999 IL – 1 Total All Submitter IDs - 3 72 First Name Sam Date of Birth Gender 01/01/1995 M Start Date 08/01/08 Program ABC 350 575 Expiration Date Exp Ind 01/31/2009 #/Days 1 1 1

Consumer Registrations Active on Requested Date Report Name Description of Report Parameters for entry Fields Generated l. Il A Summary pdf report of consumer registrations that are active on the date report was run None Submitter ID, RIN, Client ID, Last Name, first Name, Date of Birth, Gender, Registration Start date, Program Code, Program End Date, Closure Date Active Consumer Registrations by Submitter/RIN l. Il Active Consumer Registrations by Submitter/Client ID l. Il Active Consumer Registrations by RIN l. Il Active Consumer Registrations by Client ID l. Il Active Consumer Registrations by Last Name 73

Consumer Registrations Active on Requested Date - Sample Report Consumer Registrations Active on 12/20/2008 for Provider 123456789 Submitter ID 999999 RIN 123456789 231234535 client ID 000001 000612 Last Name First Name Date of Birth Gender Start Date Program Doe John 07/01/2008 ABC 121 350 575 Jones Eva 01/01/1990 10/09/1960 M F 07/01/2008 Program End Date Closure Date 10/21/2008 ABC 350 575 12/31/2008 Total for Submitter ID 999999 – 2 -------------------------------------------Page Break--------------------------------------Submitter ID 999999 IL RIN 123456321 client ID 000550 Total for Submitter ID 999999 IL – 1 Total All Submitter IDs - 3 74 Last Name Green First Name Date of Birth Gender Sam 01/01/1995 M Start Date 08/0120/08 Program ABC 350 575 Program End Date Closure Date

Closed Consumer Registrations between Begin Date and End Date Report Name Description of Report Parameters for entry Fields Generated l. Il A Summary pdf report of consumer registrations that were closed with the time frame requested Date Range – Begin date and End date (up through the day before) Submitter ID, RIN, Client ID, Last Name, first Name, Date of Birth, Gender, Registration Start date, Program Code, Closure Date, Closing Disposition, Scale used at closing, Score at closing Closed Consumer Registrations by Submitter ID/RIN l. Il Closed Consumer Registrations by Submitter ID/Client ID l. Il Closed Consumer Registrations by RIN l. Il Closed Consumer Registrations by Client ID l. Il Closed Consumer Registrations by Closed Date l. Il Closed Consumer Registrations by Last Name 75

Closed Consumer Registrations between Begin Date and End Date – Sample Report Closed Consumer Registrations between 08/01/08 and 8/31/08 for Provider 123456789 Submitter ID RIN Client ID Last Name First Name Date of Birth Gender Start Date Program Closure Date Closing Disp Scale used Score 999999 123456789 000001 Doe John 01/01/1990 M 07/01/08 ABC 121 350 575 08/01/2008 04 04 G G 75 75 999999 231234535 000612 Jones Eva 10/09/1960 F 07/01/08 ABC 350 575 08/12/2008 05 05 05 G G G 82 82 82 Total for Submitter ID 999999 – 2 -------------------------------------------------Page Break--------------------------------------------------Submitter ID RIN 999999 IL Client ID Last Name First Name Date of Birth Gender Start Date 123456321 000550 Total for Submitter ID 999999 IL – 1 Total All Submitter IDs - 3 76 Green Sam 01/01/1995 M 08/01/08 Program Closure Date Closing Disp Scale used ABC 350 575 08/31/2008 06 06 06 C C C Score 79 79 79

Consumer Registrations for RIN Report Name Description of Report Parameters for entry Fields Generated l. Il A Summary pdf report of consumer registrations for specified consumer Consumer’s RIN Submitter ID, RIN, Client ID, Last Name, first Name, Date of Birth, Gender, Registration Start date, Program Code, Program End Date, Closure Date Consumer Registration for specified RIN 77

Consumer Registrations for (RIN) – Sample Report Consumer Registrations for 231234535 for Provider 123456789 Submitter ID RIN 999999 231234535 Client ID Last Name 000612 Jones First Name Eva Date of Birth Gender 10/09/196 F Start Date Program End Date Closure Date 07/01/2008 ABC 121 575 09/15/2008 Total for Submitter ID 999999 – 1 ----------------------------------------------Page Break------------------------------------------------------------Submitter ID RIN 999999 IL 231234535 Client ID Last Name 000612 Jones Total for Submitter ID 999999 IL – 1 Total All Submitter IDs - 2 78 First Name Eva Date of Birth Gender 10/09/1960 F Start Date Program End Date Closure Date 12/10/2008 ABC 575

Registration Excel Data Sets Registration Detail –Excel format data sets of registrations that can be saved to Provider’s desktop and sorted according to provider’s preference. There will be 2 data sets – One containing Enrollment information and the other containing Clinical information Select by Registration Start Date or Date Entered. A specific date or date range is required to limit data set size. l l 79 Data Set is limited by Excel’s limitations. Providers need to plan timing and approach to extracting data

IL Consumer Registration Enrollment Data 80 Registration Number Marital Status Path Grant Begin Date MH Registration Date Employment Status Path Grant End Date Consumer ID (Recipient RIN) SSI-SSDI Eligibility CHIPS Begin Date Last Name DFI-CFI Enrollment CHIPS End Date Client First Name Court / Forensic Treatment Consumer Residential Program Begin Date Client Middle Initial Race #1 Consumer Residential Program End Date Name Suffix Race #2 Guardian 1 Type Birth Date Race #3 Guardian 1 First Name Social Security Number Race #4 Guardian 1 Middle Initial Mother’s Maiden Name Race #5 Guardian 1 Last Name Gender Hispanic Origin Guardian 1 Address Client ID Language Guardian 1 City Agency FEIN Citizenship Guardian 1 State

IL Consumer Registration Enrollment Data (con’t) 81 Satellite Code Interpreter Services Needed Guardian 1 Zip Code Medicaid Site ID MH Residential Indicator Guardian 1 Zip Code Suffix Primary Address MH Residential Arrangement Guardian 1 Appointment Date Address Line 2 Justice System Involvement Guardian 1 Termination Date City Disaster Guest Type Guardian 2 Type State Disaster Guest State Guardian 2 First Name Zip Code Disaster County Guardian 2 Middle Initial County Consumer third party payor? Guardian 2 Last Name Township/Community Area Special Program Enrollment Juvenile Justice Program Guardian 2 Address Household Income Special Program Enrollment PATH Grants Guardian 2 City Client Income Special Program Enrollment Comm Hosp Inpatient (CHIPS) Guardian 2 State Family Household Size Special residential program Guardian 2 Zip Code Household Composite Residential level of care Guardian 2 Zip Code Suffix Education Level Juvenile Justice Begin Date Guardian 2 Appointment Date Military Status Juvenile Justice End Date Guardian 2 Termination Date

IL Consumer Registration Clinical Data 82 Registration Number CGAS - Self Care History of Illness - Multiple Residential MH Registration Date CGAS - Community History of Illness - Outpatient Consumer ID (Recipient RIN) CGAS - Social Relations History of Illness - Previous Treatment Last Name CGAS - Family Relations Co-Occurring Disorders Client First Name CGAS- School Evidence Based Practice - Supported Employment Client Middle Initial GAF-Social Group/School Evidence Based Practice - IDDT Name Suffix GAF-Employment Evidence Based Practice - Medication Algorithm Birth Date GAF-Financial MH Cross Disabilities Database -Form Completion Date Gender GAF-Community Living MH Cross Disabilities Database -Primary Care Giver Age Client ID GAF-Supportive Social MH Cross Disabilities Database -Type of Services Needed 1 MH Diagnosis Code Type GAF-Daily Living Activity MH Cross Disabilities Database -Type of Services Sought 1

IL Consumer Registration Clinical Data (con’t) 83 MH Axis 1 Diagnosis 1 GAF-Inappropriate or Dangerous Behavior MH Cross Disabilities Database -Type of services Needed 2 MH Axis 1 Diagnosis 2 GAF-Previous Functional Impairment MH Cross Disabilities Database -Type of Services Needed 3 MH Axis 1 Diagnosis 3 LOCUS - Risk of Harm MH Cross Disabilities Database -Type of Services Sought 2 MH Axis 2 Diagnosis 1 Recovery-Environment-Stressor MH Cross Disabilities Database -Type of Services Sought 3 MH Axis 2 Diagnosis 2 Recovery Environment-Supports MH Cross Disabilities Database -Type of Services Needed Other Description MH Axis 2 Diagnosis 3 Functional Status MH Cross Disabilities Database -Type of Services Sought Other Description MH Axis 3 Diagnosis 1 Co-Morbidity MH Closing Date MH Axis 3 Diagnosis 2 Recovery and Treatment History MH Closing Disposition MH Axis 3 Diagnosis 3 Acceptance and Engagement Functional Scale Used at Closing MH Principal Diagnosis Indicator Level of Care Recommended Assessors GAF/CGAS Score at Closing Functional Scale Used History of Illness - Continuous Treatment GAF/CGAS Score History of Illness - Continuous Residential

Questions and Answers 84

Thank you! Illinois Mental Health Collaborative for Access and Choice