SSAM III.C Community Based Care Payment System

IV.C Community-Based Care (CBC) Provider Payment System

7/1/11

1. Overview

The Community Based Care (CBC) Provider Payment System is a computer-based information system that allows for the issuance of 512s and payments to Adult Foster Providers, Residential Care Facilities, Assisted Living Facilities, and Adult and Child DD Providers. Access to the system, or certain screens within the system, is limited to authorized individuals in each local office.

2. Frequently Used Mainframe Screens

Client Screens

SMRQ,prime# <enter>
Shows last fourteen (14) 512s by client
Enter the 512s through this screen

Screens inside the 512:

SERF – demographic information on the client
SNRS – financial information
RATZ – service rate information
SADD – names and addresses of contacts for the client. 512s are sent to these people
SBEG – allows worker to adjust the client’s service contribution for the first month of service of that particular 512. This screen only pops open when entering a new 512.
DISB – information from assessment and payment information; service amount, client contribution, room and board, needs, etc.
SCFD – summary of information from 512 including payment status and paid through date
SMSG – will show a suspend message if payment is suspended

WEBM – client informaton

WEBM,FIND,prime#
WEBM,FIND,lastname,firstname
- Displays all client info- name, SSN, Prime ID, DOB, DOD
WLGR access:
- Tab down to "Prime:<primenumber>
- Enter a character on dot, hold Shift and F1 together
UCMS access:
- Tab down to "Type Case:" the line that has a Prime ID listed and Medl Elig File listed is the active line
- Tab to the dot to the left of this line, enter a character, and hold Shift and F1

WLGR – client eligibility information

Shows case eligibility information by date lines. Includes case descriptors, program codes, branch and dates of eligibility

WLGR,prime# <enter> or access from WEBM,FIND,prime# (F3 to return to WEBM)
Go here to verify the client is eligible to be paid from APD. Client must have both APD and CBF in their case descriptors for the dates requested on an adjustment or late payment.

UCMS – client case information

Access from WEBM, or UCMS,case# <enter>
Client name, address, effective date and information pulled from CI file
Effective date is most important…512s must start on or after the UCMS effective date.
- Example: Existing 512 set up from 10/1 and continuing. If the Eff Date in UCMS is changed to 10/15, the 512 will go into suspense. You will need to touch the 10/1 512 with a 10/15 start date and an action code 1 to pull those dates into another 512. Both should be in normal status after touching.
- You can COMPUTE or SUPPLE the UCMS date back to the beginning of the month or previous month, respectively, and enter a 512.
- If you are unable to COMPUTE or SUPPLE the UCMS date back far enough to pay necessary dates, set up a 512 beginning the date of the UCMS effective date and continuing. Then submit a Late Payment Request to pay the dates prior to the UCMS effective date.

SELG -CAPS information

Must have current CAPS to pay out

Provider Screens

SPVF – Provider search

SPVF <enter>
Fill in field you wish to search by last name and first name, SSN/TIN, or business name and key <enter>
Select a line to view by placing a character next to the line and keying <enter> this will take you to PRV8.
F12 to return to SPVF

PRV8 – Provider information

PRV8,provider# <enter>
Shows all provider information- name, address, phone, DOB, provider type, living with client or not, relative provider or not, etc
Active providers will show a begin date and 12/31/9999 as a continuing provider under "Program".
Inactive providers will have an end date rather than an ongoing date. "Active" will show next to the dates of licensing, however if there is an end date, that end date is the date their provider license expired.

Payment Screens

SCFS – Payment status screen

SCFS,P,provider# <enter> shows all current 512s for that provider.
SCFS,R,prime# <enter> shows all 512s for that client.
- Go here when someone says they are missing payment for a client, or have not received payment for a client. You can view suspended or normal payments and troubleshoot if necessary.
Shows all current, ready-to-pay 512s by client or provider.
Shows any suspended payments (S = suspended, N = normal)
Lists all clients for a provider.

PESM – Payments to provider

PESM,p,provider# <enter>
Shows all payments made to the provider.
Tab down to a line of payment, put an S next to it and key <enter>. Then key F7 to see clients and amounts that were paid on that check.

SCLM – Payment history by client

SCLM,R,prime# <enter>
Shows all payments made for a client.
Key F1 to page through payments, or F4 to go to the bottom, most recent payments.

Other Screens

RCIQ – Check records

RCIQ <enter>
1 <check number> to view check.
<provider number> to view payments to provider.
View payments to see if they are paid (PD) or outstanding (OS) or to see if they have a payment alert on them and have been replaced.

PUTL - Utilities

Putl <enter>
Main menu for 512 utilities.
MRAT – option 1, calculates prorated room and board rates for clients who enter care mid-month.
DPRT – option 2, shows all 512s by branch to be printed. You can delete a 512 from being printed and sent out by placing a ‘D’ next to the line to delete, key <enter> and confirm delete with “Y” <enter>
URAT – view current rate schedules for different types of CBC.

HZIP – zip code check

HZIP, <enter>
Enter an address to find the correct zip code and Plus 4 zip code.
All addresses entered into mainframe should have a Plus-4 code to reduce postage costs.

Rate Exception Screens:

SRXQ,prime# or PROVIDERr# - displays a list of any rate exception records for the client or provider number entered; view only
- SRXI – viewable from inside SRXQ, displays detailed information on adjustment selected

3. Entering a New 512

On a clear mainframe screen, key SMRQ, prime #<enter>
- This allows you to view the most recent 512s for the client entered.
- If you are touching an ongoing 512, place a character next to that line and hit <enter> to continue to SMFR.
- If you are beginning a completely new 512, key F10 to continue to SMRF.
Once in SMRF, fill in all blanks on the form:

Prime ID
Provider Number
2nd provider, Y or N (2nd provider is used for a client's one-week trial services period with prospective provider)
Effective Begin Date-date to begin the 512
Effective End date (you cannot enter an end date; leave this as ongoing)
Operator ID (your load code)
Action Type – Change to a 1 to open a new 512 (see below for action type descriptions)

Page through the 512 using F7 to navigate through the 512.
Verify all information is correct on all the pages.
When you get to the DISB screen, you will need to specify how many prints to make and to who (provider, client, etc.) then select “Y” at the curser and F7 to complete the entry.

4. 512 Action Types

1 = New, Financial or Assessment changes, “touching the 512”

This pulls all information over to the 512 system.

4 = Viewing a 512

This is a read/print only action. It is used if you want to view or print copies of the 512.

5 = Closing a 512

This action will permanently close a 512 and cause the provider to stop being paid.

6 = Deleting a 512

Use this action to delete an unpaid 512. This action will permanently remove the 512 and all narratives from the system.

5. Error Messages When Entering a 512

Dates are within a SCF time period for same prime
- This means the client has already been paid through these dates

Go to SCLM,R,prime# to view payments by client and see what has been paid. Adjust the new 512 dates to dates which have not been setup for payment yet.

Provider not active during 512 period-Provider is not currently licensed through this time period

Verify correct provider number
If it is correct, go to PRV8,Provider# to verify when license began or ended and adjust 512 dates accordingly
If the provider is supposed to be licensed through the time period you are entering, contact licensing

CMS effective date is later than 512 effective date

The CMS effective date is in the middle of your 512 requested time frame. Verify the CMS effective date in UCMS. You will need to SUPPLE or COMPUTE back to the date you need to begin your 512, then enter the new 512 with that date. If you are unable to SUPPLE or COMPUTE back to the necessary date, you will need to submit a Late Payment Request to Provider Adjustments for dates of payment necessary prior to the UCMS effective date.

A pending 512 exists for this time. Cancel or complete it to continue

This error occurs when you are trying to enter a 512 for a time period when a pending 512 already exists.
Go into SMRQ to view 512s; the pending 512 will be marked on the right side with a "P" for Pending.
Place a character on the line next to the pending 512 and press enter to continue to SMRF.
In SMRF, change the action type to a 1 to change the 512 and press <enter> to continue.
On the next page, tab to "cancel." Enter "Y" and key <enter>.
Confirm you wish to cancel by entering "Y" at the cursor and keying <enter> again.
This will cancel the 512 so you can go back in and open one for the correct time frame.

6. Error Messages When Closing a 512

Act type not possible, Paid thru > eff date
- This means the client has already been paid through the dates you are requesting to close; you cannot close a 512 on or before a date that has already been paid. Close the 512 as of the last paid date (look up in SCLM,R,Prime#). If this resulted in an overpayment to the provider, submit an overpayment request to Payment Support.
Cannot close 512 past existing end date
- The 512 has an ending date that is before the date of closure. Either change the date of closure or change the ending date on the completed 512.

7. Common 512 Suspend Messages

Click here for a list of common 512 suspend messages

8. Late Payment Requests

When a provider has not been paid for a specific time period they are owed for, and the field is unable to enter a new 512, a Late Payment Request (SDS 0287F) will need to be submitted to SPD, Provider Adjustments, in order for Central Office to enter the payment.

Click Here for Late Payment Request form

Instructions:

Complete contact information and client/provider information at the top of the form.

Late Pay Begin Date:

Enter the date the late payment began. (Month, day, year)
This is the first day the client should have been paid.

Late Pay End Date:

Enter the date the late payment ended. (Month, day, year)
This is the last day the client should have been paid.

Client Service Contribution Amount:

This is the amount the client is mandated to pay towards their cost of care. This amount DOES NOT include room and board.
This is found in the 512 on the DISB screen near the bottom across from ‘SVC CNTRB’. Do NOT use the CLNT PAY as this includes the room and board amount.

Enter what the client should have paid for their service contribution.

If the client does not have a service contribution, enter 0 (zero).

Service Amount:

This is the full amount the State is authorized to pay for this client per month.
Do NOT prorate this amount for a partial month of service.
This is found in the 512 on the DISB screen. It is across from SERV AMT.

Do NOT use TOT DUE as this includes the room and board.
If this amount is not correct, enter the correct amount that should have been paid.

Reason for Late Payment:

Describe why the payment was late.

Example: Late Entry

Click here for example

9. Overpayment Requests

When a provider has been paid for services, but an incorrect amount was paid out, an Adjustment Request will need to be submitted.

Overpayment Request, form SDS 0287D.

Instructions: Complete contact information and client/provider information at the top of the form.

Overpayment Begin Date:

Enter the date the overpayment began. (Month day year)

This is the first date the client was paid for, but should NOT have been paid for.

Overpayment End Date:

Enter the date the overpayment ended. (Month, day year)

This is the last date the client was paid for, but should NOT have been paid for.

Client Service Contribution Amount:

This is the amount the client is mandated to pay towards their cost of care. This amount DOES NOT include room and board.
This is found in the 512 on the DISB screen near the bottom across from ‘SVC CNTRB’. Do NOT use the CLNT PAY as this includes the room and board amount and we do NOT calculate in room and board.

If the service contribution is correct in the 512 being adjusted, enter that amount.
If this amount is not correct in the 512, but is the cause of the overpayment, please enter the correct service contribution the client SHOULD have paid on the form. Do NOT include room and board.

If the client does not have a service contribution, enter 0 (zero).

Service Amount:

This is the full amount the State is authorized to pay for this client.
Do NOT prorate this amount for a partial month.
This is found in the 512 on the DISB screen. It is across from SERV AMT.
Do NOT use TOT DUE as this amount includes the room and board.

If this amount is not correct, enter the correct amount that should have been paid.

Incorrect Payment:

This is the amount the provider was paid incorrectly.
This amount is in SCLM,R,prime number. Key F1 to page through to the month you want corrected, or key F4 to go to the last page (most recent payments).
Enter the total amount the State paid to the provider for the client in the time frame you are adjusting.

Example: If you are submitting an adjustment for May, only include the incorrect payment for May.

Correct Payment:

This is the amount the provider should have been paid.
- Full month of service:

If the client does NOT have a service contribution, the correct payment is the full service amount.
If the client does have a service contribution, subtract the client’s service contribution from the Service amount.

Partial month of service:

You will need to do some math to figure out what the provider should have been paid for the partial month. Use the following example and equation:

Service amount: $1490.00
Client Service Contribution: $100
Month: June (30 days)
Days in the home: 10
Number of days the client was with the provider, divided by the number of days in the month:

10/30 = 0.3333 (This is the percentage of time in the month the client was with the provider. Truncate at the 4th decimal place and do not round.)

Percentage of time with the provider, multiplied by the monthly service amount:

03333 x 1491 = $496.95 (This is the total amount owed to the provider for services)

Total owed to the provider; subtract the client service contribution amount:

496.95 – 100.00 = $396.95 (Do not round. This is the total the State owes to the provider.)

Reason for Adjustment:

Briefly describe why the adjustment is being made.
Example: Client went to hospital. Returned to facility on 6/15.

Click here for example

10. Underpayment Requests

Underpayment Request, form SDS 287C.

Instructions: Complete contact information and client/provider information at the top of the form.

Underpayment Begin Date:

Enter the date the underpayment began. (Month, day year)

This is the first date the client SHOULD HAVE been paid for.

Underpayment End Date:

Enter the date the underpayment ended. (Month, day year)

This is the last date the client SHOULD HAVE been paid for.

Client Service Contribution Amount:

This is the amount the client is mandated to pay towards their cost of care. This amount DOES NOT include room and board.
This is found in the 512 on the DISB screen near the bottom across from ‘SVC CNTRB’. Do NOT use the CLNT PAY as this includes the room and board amount and we do NOT calculate in room and board.

If the service contribution is correct in the 512 being adjusted, enter that amount.
If this amount is not correct in the 512, but is the cause of the underpayment, please enter the correct service contribution the client SHOULD have paid on the form. Do NOT include room and board.

If the client does not have a service contribution, enter 0 (zero).

Service Amount:

This is the full amount the State is authorized to pay for this client.
Do NOT prorate this amount for a partial month.
This is found in the 512 on the DISB screen. It is across from SERV AMT.

Do NOT use TOT DUE as this includes the room and board.
If this amount is not correct, enter the correct service amount that that should have been paid.

Incorrect Payment:

This is the amount the provider was paid incorrectly.
This is found in SCLM,R,prime number. Key F1 to page through to find the month you want corrected, or key F4 to go to the last page (most recent payments).
Enter the total amount the State paid to the provider for the client in the time frame you are adjusting.

Example: If you are submitting an adjustment for May, only include the incorrect payment for May.

Correct Payment:

This is the amount the provider should have been paid.
Full month of service:

If the client does NOT have a service contribution, the correct payment is the full service amount.
If the client does have a service contribution, subtract the clients’ service contribution from the Service amount.

Partial month of service:
- You will need to do some math to figure out what the provider should have been paid for the partial month. Use the following example and equation:
Service Amount: $1490.00
Client Service Contribution: $100.00
Month: June (30 days)
Days in home: 10
Number of days the client was with the provider, divided by the number of days in the month:

10/30 = 0.3333 (This is the percentage of time in the month the client was with the provider. Truncate at the 4th decimal place and do not round.)
Percentage of time with the provider, multiplied by the monthly service amount:

03333 x 1491 = $496.95 (This is the total amount owed to the provider for services)
Total owed to the provider; subtract the client service contribution amount:

496.95 – 100.00 = $396.95 (Do not round. This is the total the State owes to the provider.)

Reason for Adjustment:

Briefly describe why the adjustment is being made.

Example: Client income level changed beginning June 1st

NOTE: The payment system CANNOT pay for the same month, in same month, twice.

For example: If a provider received payment for a client for June services on July 1st, they cannot be paid for June services a second time in July. Any adjustments to this payment will be entered into the payment system and will wait until the first check run of August to go out.

Click Here for Example

11. Adjustment Calculation

Use the following equation to determine what the state owes to a provider any time you submit an adjustment request.

Example:

Service amount: $1491.00

Client Service Contribution: $ 100.00

Month of Service: June (30 days)

Days client was in the facility: 10

Number of days client was in the facility, divided by # of days in the month (truncate at 4 decimal places and do not round):

Example: 10/30 = 0.3333

Truncate 4 decimal places and do not round. This is the percentage of time in the month in which client was in the facility.

Percentage in the facility, multiplied by the service amount:

Example: 0.3333 x 1491 = 497.95

Truncate 2 decimal places and do not round. This is the total owed to the provider for services.

Total owed to the provider; subtract the client service contribution:

Example: 497.95 – 100 = 397.95

This is the amount to be paid by the State.

Things to remember:

The State does not pay for the day of move out for any reason.
The Client Service Contribution is never pro-rated. It is the “first dollar” paid to the provider and is owed at the beginning of the month at 100%. The state picks up the balance to the provider AFTER the service contribution has been paid.
Do calculations based on days the client is IN the home, rather than days the client was away from the home.
The State cannot issue two payments for the same dates of service within the same calendar month. If payment for September issued on October 1st, an adjustment to the September payment will not issue until the first check run of November.

12. Earnings Statement vs. 1099's

Providers who live in the home with their clients are paid income which is ‘non-reported’ to the IRS. They do NOT receive a 1099 for tax purposes. Residence status can be viewed in PRV8 at the bottom right corner under “Res:” Y means they are licensed as living in the home with the clients. For more information on non-reported income, the provider and/or their tax consultant may refer to IRS Publication 525.

Providers with a residing status of N are licensed as not living in the home with the clients. These providers are paid income which IS reported to the IRS. They will receive a 1099 to be mailed on or before January 31st of the next year with their taxable income listed; this needs to be filed with their taxes.

Changes to a provider’s residing status need to be made through licensing and you can refer the provider to their licensor.

13. Print Remittance Advices

On a blank screen, type PESM,p,provider#
Tab down to date range provider has requested. Write down CHK DATE(S) needed, or print PESM screen for multiple RA’s
On a blank main frame page, type RD2 <enter>

View Direct Screen:

            1. Recipient ID: HSbranch #

            2. Password: Branch #

            3. Report/topic/queue ID: SJD2450R <enter>

Reports Screen:

1. It should be the report with Remittance Advice on top.

2. On the line, type an S <enter>

Reports Versions Screen:

Look for the date of the firs remittance advice that you need to print. Ex: 11/17/09. The system reads YYYY/MM/DD.
Type an S on the line to pull it up. If it says “available” under the status, then it will pull right up, but if it says “recall required,” you will have to wait for the system to recall it. Sometimes it is right away, but sometimes it is a few hours.
Once inside the RA you wish to print, on the command line, type F<space>provider#<enter>

a. If it doesn’t come up and there is an error “string not found,” that means that you are in the wrong date. F3 takes you back out to the previous screen.

b.If an error comes up "10000 lines searched," you need to press F5 until the correct RA comes up.

To print the report, key F2<enter>.

Printing Menu:

If you need more then one page, you will need to change the number of pages to be printed.

Ex: from = = > page: 000001
To = = > page: 000003

Number of pages to be printed: 000001 (default setting). Increase it to 000003.

Online Printer ID: enter the name/location of your local printe
r
<enter> <enter> (must hit enter twice! Will say “to print” at top)

The only time you will need to change the ‘TO’ and ‘Number’ of pages is if there is more than one client being paid for that time period. Otherwise, you will only need to put in your printer ID. Once you print it and you see that you didn’t get the page with the RA total and YTD totals on it, you will need to change the number of pages and reprint.
Key F3 until you are out of the program.

14. Who to Call for Help

CMS Questions	Service Desk	503.945.5623
MMIS Questions	Client Maintenance	503.378.4369
CAPS Questions	Service Desk	503.945.5623
Provider Questions	Payment Support	503.947.1141
512 Questions
512 Policy Questions	Michael Avery	503.945.6410
512 Exceptions	AFH- Carol Mauser	503.947.2321
	RCF-Debra Concidine	503.945.6404
DD Payments	Kristen Hutton	503.945.6741
APD Payments	Kristen Hutton	503.945.6741
Mental Health	Veronica Gentle	503.947.5031
Licensing Inquiries
Adult DD	Susan Eggert	503.945.7804
Child DD	Beth Shellenbarger	503.945.5676
Adult APD	Local Licensing Office
RCF/ALF	Rebecca Mapes	503.945.5839