IX. Provider payment systems

07/13/2018

A. Criminal records check

Criminal Records Information Management System (CRIMS)

See the Criminal Records Information Management System (CRIMS) website for information, demonstration, screen shots, and manual.

Background Check Unit (BCU)

The Background Check Unit (BCU) provides background check services and support to all DHS and Oregon Health Authority (OHA) divisions for employment purposes, for those who provide services or seek to provide services as a contractor, subcontractor, vendor or volunteer, or are employed by qualified entities that provide care and are licensed, certified, registered or otherwise regulated by DHS or OHA.

Please visit the BCU website for more information.

B. Community-Based Care (CBC) provider payment system

The Community Based Care (CBC) provider payment system is a computer-based information system for the issuance of 512s and payments to Adult Foster Care providers, Residential Care Facilities (RCF), Assisted Living Facilities (ALF), and Adult and Child Developmental Disabilities (DD) providers. Access to the system, or certain screens within the system, is limited to authorized individuals in each local office.

Earnings statement vs. 1099s. Please refer tax questions to either a tax professional or the IRS.

1.   Frequently used mainframe screens

A.   Consumer payment screens.

• SMRQ,prime# <enter>. Indicates the last fourteen (14) 512s by consumer.

Screens inside the 512:

• SERF – Demographic information about the consumer;
• SNRS – Financial information;
• RATZ – Service rate information;
• SADD – Names and addresses for consumer contacts where 512s may be sent, if selected;
• SBEG – Automatically opens when a new 512 is entered to allow the consumer’s service contribution to be adjusted for the first month of service;
• DISB – Payment information including service amount, consumer contribution, room and board, needs total, state and consumer pay total;
• SCFD – Summary of information from the 512 including payment status and paid-through date;
• SMSG –Displays a suspend message if the payment is suspended.

WEBM – consumer case information. Displays consumer information including name, Social Security number (SSN), prime number, date of birth (DOB), and date of death (DOD).

• WEBM,FIND,prime# or WEBM,FIND,lastname,firstname;
• WLGR access:

• Tab to Prime and enter the consumer’s prime number;
• Hold down the Shift key and press F1;
• Press F3 to return to WEBM.

• UCMS access:

• Tab down to Type Case;

-   The line with a Prime ID and Medl Elig File listed is the active line;

• Enter any character on the dot at the left of this line;
• Hold down the Shift key and press F1;
• Press F3 to return to WEBM.

WLGR – consumer eligibility information. Displays case eligibility information by date lines. Includes case descriptors, program codes, branch, and dates of eligibility. Consumers must have both APD and CBF case descriptors to be eligible for a CBC 512 payment.

• WLGR,prime# <enter>,or access from WEBM,FIND,prime#;

• Tab down to Prime and enter the consumer’s prime number;
• Enter any character on the dot at the left of this line;
• Hold down the Shift key and press F1;
• Use F3 to return to WEBM.

UCMS – consumer case information. Displays the consumer name, address, effective date, and information pulled from the consumer information (CI) file.

• Access from WEBM, with UCMS,case# <enter>;
• Case effective date; 512s must start on or after the UCMS effective date. Any 512s necessary prior to the UCMS effective date must be entered at Central Office via an APD 0287F, CBC Late Payment Request form;

• 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. Touch the 10/1 512 with a 10/15 start date and an action code 1 to begin a new 512 on the start date entered. Both 512s should be in Normal status after touching;

-   COMPUTE or SUPPLE the UCMS date back to the beginning of the month or previous month and enter a 512;

-   If 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 submit an APD 0287F, CBC Late Payment Request to pay dates prior to the UCMS effective date.

SELG - CAPS information.

• The consumer must have current and correct CAPS for a 512 payment to issue.

B.   Provider screens

PRV8 – Provider information. PRV8,provider# <enter>. Displays all provider information.

• Active providers show an end date of 12/31/9999 under Program;
• Inactive providers have an end date when their license expired rather than an ongoing date.

• Note: Active will show next to the dates of licensing, even if a provider is no longer active.

• Indicates if the provider is licensed for serving consumers in their primary residence under with either a Y or N Facility.

o   The designation affects the provider’s tax liability, per IRS Publication 525.

SPVF – Provider search. SPVF <enter>;

• Fill in the search field by last and first name, SSN/TIN, or business name and press <enter> to search;
• Enter any character on the dot at the left of this line and press <enter> to open PRV8;
• Use F12 to return to SPVF.

C.   Payment screens

PESM – Payments to provider. PESM,p,provider# <enter>. Displays payments issued to the specified provider number.

• Type an S next to the payment line and press <enter> to view;
• Use F7 to go to SCLM to view consumers and amounts paid;
• Payments issued via direct deposit will show under EFT Nmbr and EFT Date;
• Payments issued via check will show under Chk Nmbr and Chk Date;
• Provider year-to-date (YTD) earnings show on the right of the screen under Prov YTD.

SCFS – Payment status screen. This is a good screen to begin troubleshooting missing payments if the missing payment does not appear on a full suspend list or report.

• SCFS,P,provider# <enter>. Displays current and open 512s and consumers for the provider number specified;
• SCFS,R,prime# <enter>. Displays current and open 512s for the consumer specified;

o   Indicates suspended payments: S = suspended, N = normal.

SCLM – Payment history by consumer. SCLM,R,prime# <enter>.

• Displays payments made for a consumer, dates of payment, issued amount, provider name, and the provider number which received the payments;
• Use F1 to page through payments;
• Use F4 to go to the bottom for the most recent payments.

D.   Other screens

HZIP – zip code check, HZIP, <enter>.

• Enter an address to find the correct Zip Plus-4 code;
• Note: All addresses entered into mainframe should have a Plus-4 code to reduce postage costs.

PUTL – Utilities, Putl <enter>. Main menu for 512 utilities.

• MRAT – Option 1 calculates prorated room and board rates for consumers who enter care mid-month;
• DPRT –Option 2 displays all 512s by branch which are waiting to be printed.

o   Delete a 512 from printing and mailing out by placing a D next to the line to delete; press <enter>, and confirm delete with Y <enter>;

• URAT – View current rate schedules for different types of CBCs.

RCIQ – Check records, RCIQ <enter>. Displays check information as paid (PD), outstanding (OS), if there is a payment alert, or has been replaced.

• 1 <check number> to view a check;
• 2 <provider number> to view checks issued to a provider.

E.    Rate exception screens:

• SRXQ,prime# or provider# - View only the list of rate exception records for the consumer or provider number;
• SRXI – Viewable from inside SRXQ, displays detailed information on adjustment selected.

2.   Entering a new 512

On a clear mainframe screen, type SMRQ,prime# <enter>;

• Displays the most recent 512s entered for the consumer;
• If touching an ongoing 512, type any character next to that line and press <enter> to continue to SMFR;
• If beginning a new 512, type F10 to continue to SMRF.

In SMRF, fill in all blanks on the form, if entering a new 512:

·        Prime ID;

·        Provider number;

·        2nd provider, Y or N; used when a consumer is staying with a new provider for a trial visit. A second provider can only be entered for seven (7) days and the system will automatically truncate to seven (7) days if entered for longer;

·        Effective Begin Date - date to start the 512;

·        Effective End Date - cannot be entered;

·        Operator ID - 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;
• On the DISB screen, specify how many prints to make and to whom they will be sent;

• Select Y at the cursor, and F7 to complete the entry.

3.   512 action types

• 1 = New, financial, or assessment changes; “touching the 512”

• Pulls new information and changes over to the 512 system.

• 4 = Viewing a 512

• Read/print only to view or print copies of the 512.

• 5 = Closing a 512

• Permanently close a 512 and stop paying the provider as of the close date.

• 6 = Deleting a 512

• Use to delete an unpaid 512 and permanently remove the 512 and all narratives from the system.

4.   Error messages

A.   Entering a 512

Dates are within an SCF time period for same prime. The consumer has already been paid through these dates, or there is already a 512 setup for these dates

• Go to SMRQ,prime# to view 512s for the specified consumer. Adjust the new 512 dates to those dates which have not already been setup for payment.

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

• Verify the correct provider number;
• If the provider number is correct, go to PRV8,provider# to verify when the license began or ended and adjust 512 dates accordingly;
• If the provider is supposed to be licensed through the time period entered, contact licensing.

CMS effective date is later than 512 effective date. The CMS effective date is in the middle or before the 512 requested time frame

·        Verify the CMS effective date in UCMS;

·        SUPPLE or COMPUTE back to the date needed to begin the 512 and enter the new 512 with that date;

·        If unable to SUPPLE or COMPUTE back to the necessary date, enter the new 512 beginning as of the CMS effective date and submit an APD 0287F, CBC Late Payment Request, for dates of payment necessary prior to the UCMS effective date.

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

• Go into SMRQ to view 512s. The pending 512 will be marked on the right side with a P for Pending;
• Complete, close, or delete the pending 512 before continuing with the new 512.

B.   Closing a 512

Act type not possible. (Paid thru > eff date.) The consumer has already been paid through the dates requested to close. A 512 cannot be closed on or before a date already paid.

• Close the 512 as of the last paid date shown on SCLM,R,Prime#).If this resulted in an overpayment to the provider, submit an APD 0287D, CBC Adjustment Request Overpayment form to Payment Support.

Cannot close 512 past existing end date. 512 has an ending date before the date of closure.

• Close the 512 before, or as of, the existing end date.

C.   Suspend messages

• Click here for a list of common 512 suspend messages

5.   Adjusting payments

Late payments. When a provider has not been paid for a specific time period for which they are owed and the staff member is unable to enter a new 512, an APD 0287F Late Payment Request must be submitted to Apd-dd cbcpayments on Outlook, or apd.dd-cbcpayments@state.or.us for Central Office to enter the payment.

Complete all contact, consumer, and provider information at the top of the form.

1. Late pay begin date:

o   Enter the date the late payment is to begin: month, day, year. This is the first day the provider should have been paid.

2. Late pay end date:

o   Enter the date the late payment is to end: month, day, year. This is the last day the provider should have been paid.

3. Consumer service contribution amount: Amount the consumer is mandated to pay towards their own cost of care for the specified dates only.

o   Does not include room and board or other needs;;

o   Amount is found in the 512 on the DISB screen near the bottom right across from SVC CNTRB;

o   Do NOT use the CLNT PAY which includes the room and board amount;

­   Enter what the consumer should have paid for their service contribution. If the service contribution in DISB is incorrect, enter the correct amount of what the consumer owes for the dates requested on the late payment request;

­   If the consumer does not have a service contribution, or does not owe a service contribution for the dates requested, enter 0 (zero).

4. Service amount: Full monthly service rate/amount the State is authorized to pay for the consumer, per month.

o   Include the full monthly amount on the payment requests;

o   Do NOT prorate this amount for a partial month of service;

o   Amount is found in the 512 on the DISB screen across from SERV AMT;

­   Do NOT use TOT DUE which includes the room and board;

­   If the service amount is not correct on the 512 enter the correct amount that should have been used for payment.

5. Reason for late payment: Describe why the payment was late.

o   Example: Late entry;

o   Click here for example.

Overpayment requests. When a provider has been paid for services, but an incorrect amount was paid, an APD 0287D, CBC Adjustment Request Overpayment form must be submitted. Complete all contact, consumer, and provider information at the top of the form.

1. Overpayment begin date:

o   Enter the date the overpayment began: month, day, year. This is the first incorrect date for which the consumer was paid;

• Example: If January paid from the 1^st – 31^st, but the consumer moved out on the 25^th, the begin date would be January 1^st as the whole payment needs to be adjusted.

2. Overpayment end date:

o   Enter the date the overpayment ended: month, day, year. This is the last date for which the incorrect payment occurred;

• Example: If January paid from the 1^st – 31^st, but the consumer moved out on the 25^th, the end date would be January 31^st as the whole payment needs to be adjusted.

o   Consumer service contribution amount: Amount the consumer is mandated to pay towards their cost of own care for the specified dates only.

o   Does not include room and board or other needs;

­   Amount is found in the 512 on the DISB screen near the bottom right across from SVC CNTRB.

­   Do NOT use the CLNT PAY which includes the room and board amount;

­   Enter what the consumer should have paid for their service contribution. If the service contribution in DISB is incorrect, enter the correct amount the consumer owes for the dates requested on the late payment request;

o   If the consumer does not have a service contribution, or does not owe a service contribution for the dates requested, enter 0 (zero).

3. Service amount: Full monthly service rate/amount the State is authorized to pay for the consumer, per month;

o   Include the full monthly amount on the payment requests;

o   Do NOT prorate this amount for a partial month of service;

o   Amount is found in the 512 on the DISB screen across from SERV AMT;

­   Do NOT use TOT DUE as this includes the room and board;

­   If the service amount is not correct on the 512, enter the correct amount that should have been used for payment.

4. Incorrect payment: Amount the provider was incorrectly paid for the dates specified.

o   Payments by the consumer can be found on SCLM,R,prime#.

­   Use F1 to page through to the month to be corrected;

­   Use F4 to go to the last page for the most recent payments;

o   Enter the total amount the State paid for the dates of the requested adjustment;

­   Example: If submitting an adjustment for January 1st – 31st, fill in the payment for January 1^st - 31^st that issued, but is incorrect.

5. Correct payment: Amount the provider should have been paid for the dates requested.

o   Full month of service;

­   If the consumer does NOT have a service contribution, the correct payment is the full service amount;

­   If the consumer does have a service contribution, subtract the consumer’s service contribution from the service amount;

o   Partial month of service:

­   Determine what the provider should have been paid for the partial month by using our standard calculation: CBC Service Payment Calculation form.

6. Date client left facility (MM/DD/YY).
7. Date client returned to the facility (MM/DD/YY).
8. Reason for adjustment: Briefly describe why the adjustment is requested.

o   Example: Consumer went to hospital on 1/15 and returned to facility on 1/19;

o   Click here for example.

C. Underpayment requests. Complete all contact, consumer, or provider information at the top of the form

• SDS 287C Underpayment Request.

1. Underpayment begin date.

o   Enter the date the underpayment began: month day year;

o   This is the first date for which the consumer was incorrectly paid;

­   Example: If January paid from the 1st – 31st, but the consumer has an exception as of the 25th, the begin date would be January 1st as the whole payment needs to be adjusted.

2. Underpayment end date.

o   Enter the date the underpayment ended: month/day/year;

o   This is the last date for which the incorrect payment occurred;

­   Example: If January paid from the 1st – 31st, but the consumer has an exception as of the 25th, the end date would be January 31st as the whole payment needs to be adjusted.

3. Consumer service contribution amount.

o   This is the amount the consumer is mandated to pay towards their cost of care for the specified dates only. This does not include room and board or other needs; it is only a service contribution.

­   The amount is found in the 512 on the DISB screen near the bottom right across from SVC CNTRB;

­   Do NOT use the CLNT PAY as this includes the room and board amount;

­   Enter what the consumer should have paid for their service contribution. If the service contribution on DISB is incorrect, enter the correct amount of what the consumer owes for the dates requested on the late payment request;

o   If the consumer does not have a service contribution, or does not owe a service contribution for the dates requested, enter 0 (zero).

4. Service amount:

o   This is the full monthly service rate/amount the State is authorized to pay for the consumer, per month;

o   Include the full monthly amount on the payment requests - Do NOT prorate this amount for a partial month of service;

o   The amount is found in the 512 on the DISB screen across from SERV AMT;

­   Do NOT use TOT DUE as this includes the room and board;

­   If the service amount is not correct on the 512, enter the correct amount that should have been used for payment.

5. Incorrect payment:

o   This is the amount the provider was incorrectly paid for the dates specified;

­   Payments by consumers can be found in SCLM,R,prime#. Press F1 to page through to the month to be corrected, or press F4 to go to the last page for the most recent payments;

o   Enter the total amount the State paid for the dates of the requested adjustment;

­   Example: If submitting an adjustment for January 1st – 31st, fill in the payment for January 1st - 31st issued, but is incorrect.

6. Correct payment:

o   This is the amount the provider should have been paid for the dates requested;

­   Full month of service: If the consumer does NOT have a service contribution, the correct payment is the full service amount;

­   If the consumer does have a service contribution, subtract the consumer’s service contribution from the Service amount.

o   Partial month of service:

­   Determine what the provider should have been paid for the partial month by using our standard calculation: CBC Service Payment Calculation form.

7. Reason for adjustment:

o   Briefly describe why the adjustment is being made;

­   Example: Consumer income level changed beginning January 1st.

o   Click here for example.

D. Adjustment calculation tips. The CBC Service Payment Calculation form is available on the APD Case Management Tools website.

• The State does not pay for the day of move out for any reason;
• The consumer service contribution is never pro-rated to pay throughout the month. It is the “first dollar” paid to the provider and is owed to the provider in its entirety at the beginning of the month. The State picks up the balance to the provider AFTER the service contribution has been paid;
  
  
• Complete calculations based on the days the consumer is IN the home, rather than days the consumer was away from the home;

• Payments issue on the night of the first of each month and Wednesday nights thereafter; checks mail the next business day.
• Direct Deposit payments are sent to the Department of Treasury and out to individual banks for processing the next business day as well. Banks have up to three (3) banking days to deposit funds into provider accounts; banking days do not include weekends or holidays. This is a federal mandate and not something which DHS has ability to alter.

C. Customer Employed Provider (CEP) payment system

The Customer Employed Provider (CEP) payment system is a computer-based information system which allows for the issuance and payment of vouchers to enable homecare workers (HCWs) to be paid for the care they provide to APD customers.

Access to the CEP system is limited to authorized individuals in each local office.

Provider information screens

• SVDM - Voluntary union deduction menu accesses several screens related to union deductions, paid leave, and health insurance;
• SPVF,Social Security# - Look up provider by Social Security number;
• SPVF,provider# - Search by provider number;
• SPVF,providername - Search by provider name;
• PRV8,provider# - Provider information detail.

Issue and pay voucher screens

• HATH,prime #,provider # - Online entry of authorization to generate a Medicaid voucher;
• OATH, prin=me #,provider#– Online entry of authorization to generate an OPI voucher;
• HPAY,voucher# - Pay a Medicaid provider;
• OPAY, voucher# – Pay an OPI provider;
• HRDY,branch# - Vouchers by branch in ready-to-pay status; voucher information can be printed at the local office printer.

Payment history screens

• HATH,voucher# - Inquire about a particular voucher;
• HINQ,P,provider# - Displays payment history for the provider;
• HINQ,V,voucher# - Information regarding a particular voucher;
• HINQ,R,prime# - All vouchers for a particular customer;
• HINV - Basic voucher detail; to access, select voucher from HINQ;
• HDTL - Service dates, hours, gross wages, mileage, and deduction detail for the selected voucher; to access, F10 from HINV;
• HSVC - Summary of services and detail for each service; to access, press F10 from HINV or F11 from HDTL;
• HPAD, bracnh#,YYMMDD – All paid vouchers for the branch; voucher information can be printed at the local office printer.;

• HFIQ,provider# - Tax information by quarter and year; can be used for employment verifications;
• RCIQ – Check status screen;

§  Check number – Displays when the check was issued and paid;

§  Payee ID number – Displays all payments for this provider;

§  Payee name (partial) – Displays all payments for this provider;

§  Payee name (exact spelling) – Displays all payments for this provider.

Paid leave available screens

• HRSP,provider#- Paid leave hours earned for live-in providers;
• SHLQ,provider#- Paid leave hours earned for hourly providers.

Recoupments, deductions, and garnishment screens

• SLIA,P,provider#- Displays if a provider has had recoupments, garnishments, voluntary deductions, or similar activity;
• SUDI,provider#- Information about SEIU dues deductions and is a HCW is a union member or fair share; access this screen through SVDM;
• SPRQ,provider#- Recoupments when an adjustment is due to an overpayment;
• SHHW,provider#- Number of hours worked each month for health insurance;
• SVDM - Voluntary union deduction menu. Accesses several screens related to union deductions, leave, and health insurance.

D. Resources

CMS questions
MMIS questions	Client Maintenance	503-378-4369
CAPS questions	Service Desk	503-945-5623
Provider questions	Provider Relations	503-947-1141
512 questions
512 policy questions	Michael Avery	503-945-6410
512 exceptions	Margaret May	503-945-3418
DD payments	Coleen Thompson	503-945-6741
APD payments	Coleen Thompson	503-945-6741
Mental health	DMAP	503-947-5031
Licensing inquiries
Adult DD	Susan Eggert	503-945-7804
Child DD	Local licensing office
Adult APD	Local licensing office
RCF/ALF	Becky Mapes Debra Concidine Warren Bird	503-373-2076- 503-373-1975 503-373-1959