MMIS In Home Services Plan of Care (POC) Guide …€¦ · [1] Introduction The MMIS In Home Services Plan of Care (POC) Guide provides the information you need to search for and

MMIS In Home Services Plan of Care (POC)

Guide 15.10 v0.6

Training Packet

(March 18, 2013)

MMIS In Home Services Plan of Care Guide – Training Packet

Deliverable 15.10 v0.6 (March 18, 2013)

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HP Confidential Copyright © 2011, Hewlett Packard Corporation. All rights reserved.

Table of Contents

Table of Contents __________________________________ 2

[1] Introduction____________________________________ 3

[2] HIPAA: Security & Confidentiality ___________________ 4

[3] MMIS Training __________________________________ 5

[4] MMIS Access & Permissions________________________ 6

[5] View an Existing Plan of Care ______________________ 7

[6] Set up In Home Agency Plan of Care (1) ____________ 11

[7] Modify an In Home Agency Plan of Care _____________ 24

Modify Plan of Care Due to a Change in Agency ________ 24

Close Plan of Care Due to Client Death _______________ 34

Modify Plan of Care Due to Care Need Change _________ 40

[8] Set up In Home Agency Plan of Care (2) ____________ 47

[9] Troubleshooting – FAQ Guide _____________________ 59

[10] Additional Resources ___________________________ 62



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[1] Introduction

The MMIS In Home Services Plan of Care (POC) Guide provides

the information you need to search for and view a POC and set

up and modify an In Home Services POC. This guide contains

step-by-step instructions, panel images, and other tips and

hints for successfully entering or modifying a POC.



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[2] HIPAA: Security & Confidentiality

It is crucial that MMIS users comply with all HIPAA privacy and

security regulations. However, there is no private health

information (PHI) in this In Home Services Plan of Care (POC)

Guide. All panel images and samples have been taken from a

training environment where all data has been de-identified.

There are no references to real people or cases.



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[3] MMIS Training

From the DHS/OHA Learning Center, you can sign up for a

number of MMIS training courses available in a variety of

delivery formats. Some are offered as online self-paced classes

or webinars, and others are offered in the traditional classroom

setting. In addition to the courses offered in the DHS/OHA

Learning Center, there are also customized sessions and one-

on-one tutorials available. If you need assistance with choosing

the right course, setting up a customized session, or

scheduling a one-on-one tutorial, contact Robert Costa, MMIS

Training Manager for the Oregon Health Authority (OHA) at

[email protected].

mailto:[email protected]



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[4] MMIS Access & Permissions

Access to the MMIS is user-specific and based on the

employee’s job duties. Some employees may have both update

and read access to certain areas of the MMIS, while others

have read-only access. If you need additional access in the

MMIS to perform your job duties, such as entering a POC, talk

with your supervisor or manager.

[5] View an Existing Plan of Care

Three of the most common reasons to search for and view an

existing POC are: 1) to review a client’s POC information, 2) to

modify an existing POC, and 3) to make sure a client doesn’t

already have an existing POC in the system before setting up a

new one. Figures 1 through 8 illustrate how to search for and

view an existing POC.

1. Select Search from the POC submenu.

Figure 1 – Plan of Care Search Submenu



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2. Click adv search (advanced search).

This opens up additional fields on the panel to expand your search criteria options. See Figure 3.

Figure 2 – Plan of Care Advanced Search (1)

You can search with a variety of criteria, such as Service Auth Number or Case Manager ID.

3. Enter your search criteria and click search.


If there is more than one line item (service authorization) in an existing Plan of Care, or more than one Plan of Care, then the Search Results will display all line items. If there is only one line item in a Plan of Care, then the search will take you directly to the Plan of Care

4. Select a line item to view the Plan of Care Information panel.

Figure 4 – Plan of Care Search Results



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The Plan of Care Information and Maintenance panels open by default.

5. Select Line Item on the maintenance panel to access line items for the client’s Plan of Care.

Figure 5 – Plan of Care Information & Maintenance Panels

The Base Information and Line Item panels load.

6. Select the Line Item you wish to view and the fields below the line item will populate.

Figure 6 – Plan of Care Base Information & Line Item Panels



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The Notice Selection panel indicates which parties will receive copies of notices related to the client’s Plan of Care.

Figure 7 – Plan of Care Notice Selection

The Chronological Notes panel displays any notes entered for the Plan of Care as required by business policy.

Figure 8 – Chronological Notes Panel

[6] Set up In Home Agency Plan of Care (1)

In Home Services care plans are generally set up for one year.

The following step-by-step procedure illustrates how to set up

an In Home Care POC in the MMIS. See Figures 9 through 21.

Before setting up a new Plan of Care, always conduct a search

to ensure an existing Plan of Care isn’t already set up for the

client. You can search for care plans using a variety of criteria;

however, using the client’s prime number is the most specific.


Figure 9 – Plan of Care Search Submenu (2)



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2. Enter the search criteria and click search.

If there is no Plan of Care for this client, you will see “No rows found” in the Search Results.

Figure 10 – Plan of Care Client ID Search



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3. Click add to begin entering the new Plan of Care.

Figure 11 – Add New Plan of Care

When you click the add button, a blank POC record opens and

the following panels display in order: Plan of Care Information,

Plan of Care Maintenance, Base Information, Line Item, and

Chronological Notes.



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You begin by entering information on the Base Information panel. See Figures 12 – 13.

5. Enter the client’s prime number in the Client ID field.

When you click outside the Client ID field, the Client Name field populates.

4. Enter the appropriate MMIS user name in the Case Manager ID field.

Figure 12 – Base Information Panel Entry (1)


6. Select the Division.

7. Enter the POC Development Date (defaults to current date).

8. Enter the POC Start Date.

9. Enter the POC End Date as 12/31/2299.

The following information provides details about the field

entries on the Base Information panel.

POC Development Date: This is the date the POC was created

in the MMIS and defaults to the current date. Although you can

modify this date, you may leave the default because it does

not drive any of the processes related to a care plan, such as

claims and payments.

POC Start Date: This date must be on or before the first day

the client is to receive services. For example, if the client will

begin receving Attendant Care on March 1, 2013, then the POC



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Start Date must be March 1, 2013 or earlier. All Line Item

(service authorization) entries must fall between the POC Start

Date and POC End Date.

POC End Date: The POC End Date on the Base Information

panel is always the infinity date of 12/31/2299. This is a

DHS/OHA policy. Although an In Home Services POC is usually

set up for one year, you will still enter 12/31/2299 as the POC

End Date on the Base Information panel. If you enter a specific

POC End Date on the Base Information Panel, that entry will

close all the line items (including active ones) as of the date

you entered. This will also prevent you from making any

modifications or corrections to the care plan.



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Next you complete the Line Item panel. See Figures 14 – 19.

The most efficient way to complete the Line Item panel is to

enter information on the right side of the panel first and the

left side of the panel second. This is necessary because you

must enter the Effective Date and the End Date on the right

side of the panel in order for the benefit plans to appear in the

Benefit Plan field on the left side of the panel.

Important! Do not press the <Enter> key on your keyboard

to move from field to field on the Line Item panel. Pressing the

Enter key activates the add button, which inserts another line

item each time you press it. Use the <Tab> key to move from

field to field or click in the fields using your mouse. If you press

the Enter key or click the add button inadvertently, click cancel

on the maintenance panel and re-enter the POC, starting with

the Base Information panel. That is the easiest and most

efficient way to handle a line item added by mistake.

10. Click the add button to add a new line item and enable the fields. A Service Auth Number appears in the top left corner of the panel.

11. The Service Code Type field defaults to Procedure Code, which is correct for this service type.

12. Enter the Service Code.

13. Enter the Effective Date and End Date in the respective fields.

Figure 14 – Line Item Panel



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*Note: For Attendant and Personal Care services that are one

half hour in duration, providers will submit claims in

increments of two 15 minute services. Therefore, you must set

up the units in increments of 15 minutes on the POC. For

14. In the Units field, enter the number of hours per month X4*.

15. Select 15 Minutes in the Unit Qualifier field.

16. Select Monthly in the Frequency field.

17. Select Pay System Price in the Payment Method field.

18. Select Active in the Status field. The Dollars, Used

Dollars, and Balance Dollars fields will be disabled after you select the Pay System Price.

Figure 15 – Line Item Panel (2)



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example, if the client is to receive up to 100 hours per month

of Attendant Care, you will approve 400 15 minute units

monthly (100 X 4).


15. The Used Units field starts out as zero (0). When you click save, the Balance Units field populates with the number of units set up on the Line Item. As claims are processed, the Used Units increase and Balance Units decrease.



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15. Enter the Rendering Provider ID in the corresponding field or search for the ID by clicking [Search].

After clicking outside the Rendering Provider ID field, the provider’s Name, Address, City, State, & Zip fields populate.




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17. Select the Authorizing Entity.

18. Select Aged and Physically Disabled in the Benefit Plan field.

19. Leave the defaults in the last four fields.




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19. It is not necessary to enter the Modifiers, Reason Code, and Client Direct Dollars.

These fields indicate which parties will receive notices related to the client’s Plan of Care.

20. You may leave the default values on the Notice Selection panel or change them as needed.




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Enter Chronological Notes as required by your business policy

and save the record. See Figures 20 – 21.

Internal Note: Only DHS/OHA staff can view these notes.

External Note: These notes will also be visible to providers via

the web portal.

21. Click the add button.

22. Select Internal or External in the Type field.

23. Select SPD Note in the Short Description.

24. Enter text in the Note field.

The Note Date field is pre-populated with the date you create the note and cannot be modified.

Figure 20 – Chronological Notes Panel (2)

24. Click save on the maintenance panel to save the Plan of Care. You will see a “Save was Successful” message.

Figure 21 – Save Successful Message



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[7] Modify an In Home Agency Plan of Care

The following sections describe how to: 1) modify an In Home

Care POC because the client chooses another agency, 2) close

a Plan of Care due to the client’s death, and 3) modify an In

Home Care POC because the client’s care needs decrease.

Modify Plan of Care Due to a Change in Agency

When a client selects another In Home Agency, you end date

the line item for that service on the client’s Plan of Care. You

then add another line item for the new provider. You do not

end date the Plan of Care on the Base Information panel. You

leave End Date as the infinity date of 12/31/2299. Figures 22

through 33 illustrate how to modify a Plan of Care when a

client chooses another agency for their care.



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The Plan of Care Information and the Maintenance panels display. See Figure 24.




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3. Select Line Item on the maintenance panel to view existing line items on this Plan of Care.

The Base Information, Line Item, and Chronological Notes panels will display.

Figure 24 – Plan of Care Information & Maintenance Panels

Important! Do not change the POC End Date on the Base Information panel. Leave the end infinity date (12/31/2299).

4. Select the Line Item and the fields below will populate.

5. In the End Date field, enter the last date the current agency will provide services.

6. Select C – Closed in the Status field.

Figure 25 – Base Information & Line Item Panels

Enter Chronological Notes as required by your business policy.



the web portal.



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8. Select Internal or External from the Type field.

9. Select SPD Note in the Short Description field.



11. Click save on the maintenance panel to save the changes you made to this Plan of Care.

Figure 27 – Save Successful Message (2)

The next steps illustrate how to add a line item to this care

plan for the new agency providing services to the client.



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12. Click add to add a new blank line item.

The new line item will have a new system-generated service authorization number.

Figure 28 – Add New Line Item


14. Enter the date the new agency will begin providing services in the Effective Date field.

15. Enter the original End Date you entered when setting up the Plan of Care.

Figure 29 – Add New Line Item (2)



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16. Enter the full monthly units approved in the Units field.

17. Select 15 Minutes in the Unit Qualifer field and Monthly in the Frequency field.


19. Select Active in the Status field.


The Dollars, Used Dollars, and Balance Dollars fields will be

disabled when you select the Payment Method.

The Used Units field starts out as zero (0). When you click

save, the Balance Units field populates with the number of

units set up on the Line Item (usually around 365 days). As

claims are processed, the Used Units increase and Balance

Units decrease.



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20. Enter the Rendering Provider ID.







25. Select the Type.

26. Select the Short Description.


Note that the Service Authorization number is the same as the new line item.


28. Click save on the maintenance panel to save the the new line item you added to this Plan of Care.


Note: The case manager/person responsible for POC entry may

also use either of the following alternatives methods for

modifying the POC when the agency changes mid-month.

1. End the current provider line item as of the last day of the

last full month. Then enter a new line item for the current

provider for the partial month with partial units.

2. Enter a new line item for the new provider for the

remainder of the partial month with partial units. Then

enter a new line item for the new provider for the

remainder of the POC period for the full monthly units

approved.



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Close Plan of Care Due to Client Death

The following illustrates how to close an In Home Agency POC

due to client death. When the client passes away, you close the

line item(s) on the date the client died. You do not change any

information on the Base Information panel. See Figures 34

through 39.



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3. Select Line Item on the maintenance panel to display the existing line items on this Plan of Care.


Figure 36 – Plan of Care Information & Maintenance Panel (2)



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Important! Do not make any changes on the Base Information panel. Leave all fields as you entered them when setting up the original Plan of Care.

4. Select the line item you wish to close.

5. In the End Date field, enter the date the client died.

6. In the Status field, select “C – Closed.”

Figure 37 – Closing a Line Item



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Note that there may be multiple notes for the same service authorization (line item).

Figure 38 – Chronological Notes (5)

11. Click save on the maintenance panel to save the changes you made to the line item.




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Modify Plan of Care Due to Care Need Change Modify Plan of Care Due to Care Need Change

When there is a change to the care needs of the client you end

date the line item for that service on the client’s Plan of Care.

You then add another line item for the new service level. You

do not change any information on the Base Information panel.

Figures 40 through 51 illustrate how to modify a Plan of Care

for a decrease in care.

When there is a change to the care needs of the client you end

date the line item for that service on the client’s Plan of Care.

You then add another line item for the new service level. You

do not change any information on the Base Information panel.

Figures 40 through 51 illustrate how to modify a Plan of Care

for a decrease in care.



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3. Select Line Item on the maintenance panel to display the existing line items on this Plan of Care.


Figure 42 – Plan of Care Information & Maintenance Panels (3)



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Important! Do not make any changes on the Base Information panel. Leave all fields as you entered them when setting up the original Plan of Care.

4. Select the Line Item and the fields below will populate.

5. In the End Date field, enter the last date at the current service level.

6. Select C – Closed in the Status field.

Figure 43 – Base Information & Line Item Panels (6)



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Note that there may be multiple notes for the same service authorization (line item).


11. Click save on the maintenance panel to save the changes you made to this line item.




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12. Click add to add a new blank line item.

The new line item will have a new system-generated service authorization number.



14. Enter the first date of service with the new units in the Effective Date field.

15. Enter the original End Date you entered when setting up the Plan of Care.




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16. Enter the new number of units in the Units field.

17. Select the Unit Qualifer and the Frequency.





20. Enter the Rendering Provider ID.





25. Select the Type.



Note that the Service Authorization number is the same as the new line item.


28. Click save on the maintenance panel to save the the new line item you added to this Plan of Care.




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[8] Set up In Home Agency Plan of Care (2)

The following step-by-step procedure illustrates how to set up

an Overnight Care POC in the MMIS. See Figures 52 through

21. Before setting up a new Plan of Care, always conduct a

search to ensure an existing Plan of Care isn’t already set up

for the client. You can search for care plans using a variety of

criteria; however, using the client’s prime number is the most

specific.





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If there is no Plan of Care for this client, you will see “No rows found” in the Search Results.

Figure 53 – Plan of Care Client ID Search (2)



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3. Click add to begin entering the new Plan of Care.

Figure 54 – Add New Plan of Care (2)

When you click the add button, a blank POC record opens and

the following panels display in order: Plan of Care Information,

Plan of Care Maintenance, Base Information, Line Item, and

Chronological Notes.



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You begin by entering information on the Base Information panel. See Figures 55 – 56.

4. Enter the appropriate MMIS user name in the Case Manager ID field.

5. Enter the client’s prime number in the Client ID field.

When you click outside the Client ID field, the Client Name field populates.




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The following information provides details about the field

entries on the Base Information panel.

POC Development Date: This is the date the POC was created

in the MMIS and defaults to the current date. Although you can

modify this date, you may leave the default because it does

not drive any of the processes related to a care plan, such as

claims and payments.

POC Start Date: This date must be on or before the first day

the client is to receive services. For example, if the client will

begin receving Adult Companion Care on March 1, 2013, then

the POC Start Date must be March 1, 2013 or earlier. All Line


6. Select the Division.

7. Enter the POC Development Date (defaults to current date).

8. Enter the POC Start Date.

9. Enter the POC End Date as 12/31/2299.



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Item (service authorization) entries must fall between the POC

Start Date and POC End Date.

POC End Date: The POC End Date on the Base Information

panel is always the infinity date of 12/31/2299. This is a

DHS/OHA policy. Although an In Home Services POC is usually

set up for one year, you will still enter 12/31/2299 as the POC

End Date on the Base Information panel. If you enter a specific

POC End Date on the Base Information Panel, that entry will

close all the line items (including active ones) as of the date

you entered. This will also prevent you from making any

modifications or corrections to the care plan.



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Next you complete the Line Item panel. See Figures 57 – 62.

The most efficient way to complete the Line Item panel is to

enter information on the right side of the panel first and the

left side of the panel second. This is necessary because you

must enter the Effective Date and the End Date on the right

side of the panel in order for the benefit plans to appear in the

Benefit Plan field on the left side of the panel.

Important! Do not press the <Enter> key on your keyboard

to move from field to field on the Line Item panel. Pressing the

Enter key activates the add button, which inserts another line

item each time you press it. Use the <Tab> key to move from

field to field or click in the fields using your mouse. If you press

the Enter key or click the add button inadvertently, click cancel

on the maintenance panel and re-enter the POC, starting with

the Base Information panel. That is the easiest and most

efficient way to handle a line item added by mistake.



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10. Click the add button to add a new line item and enable the fields. A Service Auth Number appears in the top left corner of the panel.

11. The Service Code Type field defaults to Procedure Code, which is correct for this service type.


13. Enter the Effective Date and End Date in the respective fields.


The Dollars, Used Dollars, and Balance Dollars fields will be disabled after you select the Pay System Price.

10. In the Units field, enter the number of days per month.

11. Select Service in the Unit Qualifier field.

12. Select Monthly in the Frequency field.






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15. The Used Units field starts out as zero (0). When you click save the record, the Balance Units field populates with the number of units set up on the Line Item. As claims are processed, the Used Units increase and Balance Units decrease.


16. Enter the Rendering Provider ID in the corresponding field or search for the ID by clicking [Search].

After clicking outside the Rendering Provider ID field, the provider’s Name, Address, City, State, & Zip fields populate.



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igure 60 – Line Item Panel (10) F

17.

Select the Authorizing Entity.






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21. It is not necessary to enter the Modifiers, Reason Code, and Client Direct Dollars.

21. You may leave the default values on the Notice Selection panel or change them as needed.

These fields indicate which parties will receive notices related to the client’s Plan of Care.


Enter Chronological Notes as required by your business policy

and save the record. See Figures 63 - 64.



the web portal.


22. Select Internal or External in the Type field.

23. Select SPD Note in the Short Description.


The Note Date field is pre-populated with the date you create the note and cannot be modified.



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Figure 63 – Chronological Notes (7)

26. Click save on the maintenance panel to save the Plan of Care. You will see a “Save was Successful” message.




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[9] Troubleshooting – FAQ Guide

This troubleshooting FAQ information describes the most

common problems you might encounter when setting up a new

Plan of Care or modifying an existing Plan of Care and how to

fix the problems.

1. Problem: The Service Code field will not accept the

code I entered. It doesn’t display a Service Description

when I click outside the Service Code field.

Solution: You may have entered a Service Code that

does not correspond to the Service Code Type. Verify

that you chose the correct Service Code number and

that it corresponds to the Service Code Type.

2. Problem: After trying to save a new Plan of Care, I

received a message on the Maintenance panel showing

a long list of fields that need to be completed on the

Line Item panel.



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Solution: After entering a line item, you may have

inadvertently clicked the add button or pressed the

<Enter> key on your keyboard. Either of these actions

will add a new line item that you don’t need. The best

way to fix this problem is to click cancel on the

maintenance panel and start over. When you click

cancel, both line items will be removed (your original

one and the new one). Then you will re-enter your

Plan of Care information, starting with the Base

Information panel. It is possible to withdraw the extra

line item, but that method is more complicated and

time consuming than canceling and re-entering the

Plan of Care.

3. Problem: When saving a new Plan of Care, I received

the following message: “Line Item Effective Date must

be later than or equal to POC Start Date. Start Date

excludes a service authorization line item.”

Solution: You entered an Effective Date on the Line

Item panel that is before the POC Start Date on the

Base Information panel. You will need to change the

POC Start Date or the Effective Date so that the



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Effective Date on the Line Item panel is on or after the

POC Start Date on the Base Information panel. In all

care plans, the Effective Date and the End Date on the

Line Item panel must fall between the POC Start Date

and the POC End Date on the Base Information panel.

4. Problem: The correct benefit plan does not display in

the Benefit Plan drop-down list on the Line Item panel.

Solution: If the correct benefit plan is not displayed for

the type of care plan you are setting up, it is because:

1) the client is not covered by the benefit plan, or 2)

the client is not covered by the benefit plan during the

date range listed in the Effective Date and End Date

fields on the Line Item panel.

5. Problem: The Benefit Plan field on the Line Item panel

is disabled and no benefit plans display.

Solution: There are two likely possibilities: 1) you

didn’t enter the Effective Date and End Date on the

Line Item panel. The Benefit Plan field will not

populate with a list of benefit plans until you enter

both an Effective Date and an End Date on the Line



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Item panel, or 2) you didn’t enter the Client ID on the

Base Information panel.

[10] Additional Resources & Contact Information Do you need access to the APD Staff Tools Plan of Care

and Patient Liability instructions? Go to the following link:

http://www.dhs.state.or.us/spd/tools/mmis/index.htm

Do you have MMIS training-related questions? Contact

Robert Costa, MMIS Training Manager, OHA, at

[email protected]

Do you want to sign up for MMIS training? Go to the

DHS/OHA Learning Center at the following link:

https://dhslearn.hr.state.or.us If you cannot find the training

you’re looking for, contact Robert Costa.

Does your department need customized MMIS training?

Contact Robert Costa.

Are you experiencing technical issues with the MMIS,

such as not being able to log in? Contact the DHS/OHA

http://www.dhs.state.or.us/spd/tools/mmis/index.htm


https://dhslearn.hr.state.or.us/



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Service Desk at 1-503-945-5623 or

[email protected]


Documents

MMIS In Home Services Plan of Care (POC) Guide …€¦ · [1] Introduction The MMIS In Home Services Plan of Care (POC) Guide provides the information you need to search for and