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Medicaid Management Information System (MMIS) - Medicaid Billing Data
Brief Description
This module provides access to Medicaid billing data, this information will enable workers to begin gathering Washington State health information on children in Out-of-Home care. This information is based on Medicaid billing information only and does not represent a complete health history. The information may not reflect recent billing information. The data is only available from October 1998. This information is posted once a month from MAA.
Decisions regarding medical/health treatment for this child should not be based solely on this information.
For questions regarding
this data, please contact your automation trainer (the trainer will refer to
you to your local Passport nurse for medical information if necessary.)
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| Table of Contents |
| Definitions |
| Security |
|
Note: There are multiple records listed with same or similar Person ID and/or Names because the CAMIS data is matched with all data from MMIS as of October 1998. Match the MMIS child record to CAMIS child record using the following match criteria of:
|
BROWSE PERSON ID
1.
Click Browse 
.
2. Select Person, type the Person ID.
3. Click OK.
4. From the Options list, click Medicaid Billing Data.
MEDICAID BILLING DATA
This data will be displayed according to column heading order, left to right.
| Person (PRSN) ID | CAMIS Person ID. This is an unique identifier assigned by the CAMIS application. | ||
| ACES Client ID | The
identification number assigned
to an individual by ACES.
The baby's medical billing records may show up on the Mother's PIC code for up to 90 days unless;
Note:
Post natal care for a baby
typically appears on the
Mother's PIC code for up
to 90 days. |
||
| Recipient First Name | First name of the recipient of the medical services (most reliable first name known to ACES) | ||
| Recipient Middle Initial | Middle initial of the recipient of the medical services (most reliable middle initial known to ACES). | ||
| Recipient Last Name | Last name of the recipient of the medical services (most reliable last name known to ACES). | ||
| Recipient Birthdate | Birthdate of the recipient of the medical services (most reliable DOB known to ACES). | ||
| Recipient SSN | Social Security number of the recipient of the medical services (most reliable SSN known to ACES). | ||
| Recipient Sex Code | Sex of the recipient of the medical services. | ||
| Current PIC | With time names can change or birth dates can be revised to reflect accurate information. When this occurs a current PIC is assigned which is cross-referenced to the original. | ||
| Provider Name | Name of the health care provider. The provider could be an individual provider (e.g. physician) or an organization (e.g. clinic). | ||
| Provider ADDR LINE 1 | This address line 1 data represents the physical address. First line of the address of the health care provider. This could be the Corporate Headquarters or Billing Office. | ||
| Provider ADDR LINE 2 | Second line of the address of the health care provider. | ||
| Provider City | City of the address of the health care provider. | ||
| Provider State | State of the address of the health care provider. | ||
| Provider State Zip Code | Zip code of the address of the health care provider. | ||
| Provider Phone Number | Telephone number of the health care provider. | ||
| Provider Specialty | Area of medicine in which a Provider has specialized in (e.g. Oncology, Pediatrics). | ||
| Provider Type | Identifies the category of health care provider (e.g. Physician, Pharmacist). | ||
| Provider Number | The Identification number assigned to the health care provider by MMIS. | ||
| First Date Of Service | This
field is the date the service
was performed, not the date
it was billed. In the case of most providers this is very straight forward as would be the case of office visits, filling prescriptions or going to the dentist. Providers can bill services that are provided on different days on one claim and the system treats each of these as separate line items, maintaining the integrity of the dates of service with related services. To be provided per line item. |
||
| Admit Date (MMDDYYYY) | For
hospital claims this would
be the date of the first day
of the stay regardless of
the attendant revenue code
such as surgery or room. If
a child goes into the hospital
on Sept 6 and leaves on the
9th, the Admit Date is Sept
6. There can be situations
where a hospital stay lasts
for several months. In these
cases there can be interim
bills to cover a portion of
the stay. In these cases the
Admit Date would still be
the date that the stay began,
but the First date and Last
date of service would represent
a portion of the stay. For
example, a child goes into
the hospital on Sept 6 and
stays through Sept 30.
The
hospital may submit an interim
claim with an Admit Date
of Sept 6 and a First Date
and Last Date of service
Sept 6 - Sept 30. If the
unfortunate child is still
in the hospital at the end
of Oct. the hospital may
submit another claim showing
the same Admit Date of Sept
6 but with First Date and
Last Date of service being
October 1 - 31. |
||
| Procedure | The intervention made by the health care provider as a result of the diagnosis. | ||
| Diagnosis | The
medical condition, as defined
by the International Classification
of Disease (ICD-9-CM) diagnostic
code for the health care provider's
findings. See website listed
below.
Note: See HMO Adjustments in Definitions. |
||
| NDC | National
Drug Code for a prescription
made as a result of a diagnosis.
See website listed below. http://www.fda.gov/cder/ndc/database/default.htm |
||
| Program Code | A code that defines the Program of Eligibility for medical under which a client is eligible to receive medical services. | ||
| Code | Short Description | Long Description | |
| A | Aged | Aged | |
| B | Blind | Blind | |
| C | TANF-R | TANF-Former AFDC-Reg | |
| D | Fost | Foster Care-Adoption Support | |
| E | TANF-E | TANF-Former AFDC-Emp | |
| F | Food-Stamp | Food Stamps - No Medical | |
| G | Take-Ch | Take Charge Family Planning | |
| H | Othr-Child | Other Child Not Elig TANF | |
| I | Hlth-Ac-Sp | Health Access Spokane | |
| J | Fip-AFDC-R | Fip Program - Old AFDC Regular | |
| K | Fea | Fed Emerg Assist Before 7/81 | |
| M | MI | Medically Indigent | |
| N | Chip | Children's Health Ins. Program | |
| O | Fip-AFDC-E | Fip Program - Old AFDC E Prog | |
| P | Disabled | Disabled | |
| Q | Ita | Nonrecipients - No Medical | |
| R | Refugee | Refugee | |
| S | Pregnancy | Ga-U For Pregnant Women | |
| T | Oa-Psych | Old Age - Psychiatric | |
| U | Ga-U | Continuing General Assistance | |
| V | Chld Helth | Children's Health Program | |
| W | Adatsa | Substance Abuse | |
| X | Pres-SSI | Presumptive SSI | |
| Y | Bhp-S-Pre | Bhp Prog S Premium | |
| Z | Prog-H-Pre | Program H Pregnancy Premium | |
| 1 | Prog-1-Pre | Program 1 Premium | |
| 2 | Prog-2-Pre | SSI Client Premium | |
| 3 | Prog-3-Pre | SSI Delivery Case Premium | |
| 4 | Prog-4-Pre | Supp Delivery Case Premium | |
| Birthweight | Weight
of a child at birth. (Birth
weights are submitted on inpatient
claims for use in pricing.)
Recorded on the Mother's medical
billing post delivery of baby.
The baby's medical billing records may show up on the Mother's PIC code for up to 90 days unless;
Note:
Post natal care for a baby
typically appears on the
Mother's PIC code for up
to 90 days. |
||
| Original PIC | When a client is first identified as eligible, an original PIC is assigned. With time names can change or birth dates can be revised to reflect accurate information. When this occurs a current PIC is assigned which is cross-referenced to the original. As you would guess, sometimes clients have several PIC versions that are cross-walked to the original. For historical reporting purposes in MAA we use the original PIC so we can link all of clients services together. The current PIC is used on medical assistance identification cards. | ||
| Record (Rec) Import Date | It is the exact moment that the record was inserted into the SQL Server backend database, NOT when the record was CREATED in the MMIS system. Date that MAA received the billing. Billing data is received sporadically and not according to billing cycles or sequential order. | ||
SORT DATA
1. To sort data by a column heading, click on an underlined column heading title.
2.
If the column is letters it will
sort alphabetically, if numbers
it will sort smallest to largest,
and if date it will sort chronologically
oldest to newest. Remember that
when you sort, any blank or empty
fields will appear at the top
of the column.
SEARCH DATA
1. Press Ctrl + F on your keyboard.
2. The Find dialog box will be displayed.
A. Type your find criteria in the Find what field.
B. It is best to not select Match whole word only or Match case. Use these settings if you are certain of the exact spelling and case of the word.
C. If you are at the top of the window, select Down Direction. If you are at the bottom of the window, select Up Direction.
D. Click Find Next. To continue to find next click Find Next or press Alt + F.
EXPORT MEDICAID BILLING DATA TO PRINT
If you need to print, please note these conditions below:
1. You will need to have open both Excel and CAMIS. Follow these instructions to display both scaled windows to fit both on your desktop.
2. Open Microsoft Excel to a blank worksheet.
3. Click the Restore icon. Resize the Excel window to about ½ of your horizontal window. Click and drag the Excel window to move it to the left side of your desktop.
4. Open CAMIS.
A. Click Browse, select Person ID.
B. Click Medicaid Billing Data.
5.
Click the Restore icon, see small
orange outline in upper right
hand corner of graphic below.
Resize the CAMIS window to about
½ of your horizontal window.
Click and drag the CAMIS window
to move it to the right side of
your desktop.
6. Your desktop should
look similar to this graphic above.
7. On the CAMIS window, click and highlight all of the Medicaid Billing Data. This may be difficult due to the size of your CAMIS window now.
| Note: Place your cursor to the left of the first letter in the first column you wish to copy. Press and hold your Shift key down, while pressing down on Shift key, use your arrow keys to highlight text. |
8. Once your column headings and data are selected, let go of the Shift key. Click anywhere on the data selected, drag to the Excel worksheet.
9.
If you get a 
circle with a line symbol while
on the Excel worksheet,
it will not allow you to drop
a copy of the data.
10.
Look for this 
copy
cursor. This indicates that a
complete copy of the selected
data is ready to be dropped into
the Excel worksheet.
11.
The Excel worksheet will look
like the graphic below.
12. Once you have dragged the Medicaid Billing Data onto the spreadsheet, you can drop the information into a cell in your spreadsheet. When you let go of your cursor, it should look similar to graphic below.
13. You can Save your Excel Medicaid Billing Data spreadsheet.
14. While in your spreadsheet, use the Print features of Excel to print this information.
DEFINITIONSA. Suggestion: Use Print Preview to make sure you see how it will print. You may need to resize the columns and even remove unwanted columns.
| ACES | Automated Client Eligibility System |
| CAMIS | Case And Management Information System |
| DOB | Date of Birth |
| HIV | Human Immunodeficiency Virus |
| HMO Adjustment | MAA payments to HMO Plan (Capitation rate paid for child). |
| MAA | Medical Assistance Administration |
| MMIS | Medicaid Management Information System |
| PIC | Weight
of a child at birth. (Birth
weights are submitted on inpatient
claims for use in pricing.)
Recorded on the Mother's medical
billing post delivery of baby.
The baby's medical billing records may show up on the Mother's PIC code for up to 90 days unless;
Note: Post natal care for a baby typically appears on the Mother's PIC code for up to 90 days. |
| SSI | Social Security Information |
| SSN | Social Security Number |
SECURITY
Any worker that has open worker assignments to a case can have access to Medicaid Billing Data.
The Access groups listed below are the only users besides assigned workers who will have access to view the Medicaid Billing Data on Referral/Cases with an Open Worker Assignment:
To
gain access to view the Medicaid
Billing Data, please contact your
supervisor to request access from
CAMIS Help Desk.
