Medicaid Analytics Performance Portal Health Home Tracking System (MAPP HHTS) FAQs


Question Number Question Answer
Acuity Scores
1 How can I determine a member´s acuity score? Once a member has been accepted into the MAPP HHTS in either an enrollment or an outreach segment, AND that member was pre–identified as a Health Home eligible member by DOH, that member is included in the Billing Support Download (BSD) file with their assigned acuity score. The BSD file can be downloaded by Care Management Agencies, Health Homes and Managed Care Plans using the file download feature in the MAPP HHTS.

If a member accepted into the tracking system was not pre–identified as a Health Home eligible member by DOH, then they will not have a member specific Base Acuity score and therefore this field will be blank on the BSD. Members accepted into the tracking system in either an outreach or enrollment segment that have a date of service on or before 12/1/16 that do not have a pre–loaded Base Acuity score will receive the statewide average acuity score. Once that average acuity score is loaded into the system (usually occurs about once a month), that member´s acuity will be included in the BSD file as their Adjusted Acuity score.

Beginning 12/1/16 the billing rates for members being served as adults will be determined using the High, Medium, Low (HML) assessment and included in the BSD file. Part of this assessment includes Base Acuity and Risk scores; these questions will be automatically populated based on the member´s claim and encounter information. For members who do not have an Acuity or Risk score for service dates on or after 12/1/16, these questions will be ignored when the HML rates are calculated. In this case, the HML rates will be determined by the responses provided while completing the questionnaire. For DOS on or after 12/1/16 acuity scores will no longer be loaded for members that do not have a base acuity. Members that are under 21 years of age and are being served as children don´t typically have a base acuity. This is because the member was referred into the program via the community referral process instead of being identified as part of the HH eligible population by DOH. Members that are under 21 and being served as children have billing rates that are determined by the completion of the CANs–NY assessment.
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Billing
2 How does a provider know what constitutes a billable Health Home service? Below are links to information regarding the Health Home billing policy.

If you have a specific question about what constitutes a billable Health Home service, please submit a detailed email through the Health Home Program email web form or call (518) 473–5569.
3 When submitting a Health Home claim for dually eligible Medicare/Medicaid members, are we required to bill Medicare as well as any other primary carrier to receive a denial prior to submitting to Medicaid? If we are required to bill Medicare as well as other primary carriers, how can we acquire the necessary denial when Medicare´s processing system rejects Health Home claims prior to processing because the Health Home claim does not contain a valid procedure code and therefore the claim does not receive a Medicare claim denial for a submitted Health Home claim? Medicare does not reimburse for Health Home services. Medicaid does require that "providers must exhaust all existing benefits prior to the billing of the Medicaid Program" (see section Utilization of Insurance Benefits on page 14 of the NYS Medicaid Program Information For All Providers Manual). However, the fact that the claim is immediately rejected from Medicare means that Medicare does not cover Health Home services. Additionally, since Medicare does not have a Health Home or a Care Management provider type, there would be no way for a Health Home provider to enroll in Medicare. While it is up to each provider to determine what type of certification they need to satisfy the requirement that they "exhaust all existing benefits prior to the billing of the Medicaid Program," keeping a copy of this FAQ on file should be sufficient in certifying that Medicare does not reimburse for Health Home services.

For members with third party insurance, the provider should contact the member´s third party insurer to determine if that payer reimburses for Health Home services.

NYS Medicaid Program Information For All Providers Manual
4 Can I submit a Health Home claim after the 90 day billing window has expired? During the Health Home program implementation, Health Home claims that exceed the 90 day billing window should be submitted to Medicaid with delay reason delay code 3. This is a temporary allowance . DOH will notify the Health Home community when this allowance will no longer be available for the Health Home program. Delay reason code 3 should not be used if a claim is submitted within 90 days of a date of service.
5 Is there a time frame during which an HML Assessment can be deleted? Can it be deleted after the billing has been sent? There is not a time limit on when an HML Assessment can be deleted. As soon as a Provider is aware that the HML Assessment is incorrect, the Provider should delete the HML Assessment immediately and then resubmit the correct HML Assessment information, if appropriate. HH providers should use the Billing Support Download file on a regular basis to adjust any claims that have been voided and rectify their billing.
6 Why is the diagnosis code on the HML Assessment limited by character length? The diagnosis code is meant to be an ICD–10 code, hence the short length. This fields accepts up to 10 characters and is not required. For additional information, please reference the Power Point presentation at: http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/mapp_webinar_01_10_2017.pdf
7 What is the purpose of the Children´s Questionnaire and how is it different from the CANS–NY Assessment when determining billing for Children´s HH providers? The results of a completed CANS–NY Assessment inform the monthly Health Home serving children High, Medium, Low payments for a period of up to six months or until a new CANs–NY Assessment is completed. The Children´s Questionnaire is how the Provider attests on a monthly basis that a billable service was provided during the billing month.
8 Does the HML Assessment need to be completed for child members or just the CANs–NY Assessment? Each month, Providers serving members classified as a child must complete the Children´s Questionnaire for each member to attest that a billable service was provided for that member in that month. The member´s monthly rate will be based on the member´s most recent CANs–NY Assessment. Each month, members receiving services as adults must have a completed Adult HML Questionnaire to determine HML rate information and to attest that a billable service was provided to that member in that month. The member´s monthly rate is based on the HML information submitted for that month on the Adult HML Questionnaire. The Children´s Questionnaire and the Adult HML Questionnaire are required to be submitted for all HH members in Outreach or Enrollment, regardless of if a core service was provided in that given month.
9 Is there a list of medical codes for billing purposes for the Providers? DOH cannot give Providers coding advice. The Provider that is submitting the claim to Medicaid should select the code that best describes the member/services provided. A Health Home claim does require a valid diagnosis code, but the diagnosis code field in the MAPP HHTS is not required.
10 Which housing/homelessness questions are required and in what scenarios? How do I complete the new housing questions on the HML? Please explain the added housing fields (30/32) on the Billing Support Upload file. As of 12/1/16 dates of service and beyond, new questions have been added to the HML. These questions have been added to better reflect workloads that Care Managers may have based on a member´s circumstances. One area where questions have been added/revised is surrounding homelessness. The skip logic associated with these questions can be a bit confusing at first.

The first question seen on the member´s HML Assessments inner tab related to homelessness asks "Is the member homeless?"; this corresponds to field 10 on the Billing Support Upload file and is labeled ´Member Living Status´. A ´Yes´ or ´Y´ response indicates that the member is currently homeless as of the date of service of the HML Assessment. If "Yes" is answered to this question, a second question appears on the screen – "Does the member meet HUD Category 1 or HUD Category 2 level of homelessness?" This question corresponds to field 11 on the Billing Support Upload and is labeled ´HUD Category´. The response here indicates the HUD Category (1 or 2).

If the member is not homeless ("No" was answered to ´Is the member homeless?´), then a different question will appear on the screen, such as "Did the member meet HUD1 category of homelessness within the past 6 months?". This question corresponds to field 30 on the Billing Support Upload file and is labeled ´HUD1 within past 6 months´. This question is required in the Billing Support Upload file if the answer to "Is the member homeless?"/field 10 remains ´No´ in subsequent months when attesting to a billing instance, as the response does not carry over.

If "Yes" is answered to field 30 (the member was homeless within the last 6 months with HUD1 category) or the corresponding on–screen question, another question will appear on screen – "Date Member Housed". This corresponds to field 32 on the Billing Support Upload file and should only be answered if the member was homeless within the last 6 months with HUD1 category of homelessness, but is not currently homeless. You would then answer the question with the date the member found housing in a MM/DD/YYYY format.
11 How do I know what diagnosis code to put on my Health Home claim? "Diagnosis Code" is a HIPAA required field on all claims. This field must be populated by a valid diagnosis code, including unspecified codes. It is up to the provider to determine which diagnosis code should be used on the claim. DOH cannot give providers claims coding advice.

Please note that there is also a diagnosis code field in the monthly HML Billing Questionnaire. The diagnosis code in this questionnaire is meant to be an ICD–10 code. This field accepts up to 10 characters and is not required.

For additional information, please reference the Power Point presentation here.
12 How do I know what revenue code to put on my Health Home claim? Revenue code is a HIPAA required field on all claims. This field must be populated by a valid revenue code, including unspecified codes. It is up to the provider to determine which revenue code should be used on the claim. DOH cannot give providers claim coding advice.
13 How do ACT providers bill? ACT services, including HH services, are considered in–plan benefits for members enrolled in Managed Care Plans. ACT providers should bill MCPs directly for the ACT services they provided. ACT services, including HH services, for FFS members are billed for by the ACT provider and directly to eMEDny. However, HH members who are also in ACT are still expected to record their member´s enrollment segments in the MAPP HHTS; ACT providers are also expected to complete monthly HML Billing Questionnaires as appropriate.

The Rate Description file on the BSD displays a special message for ACT members – "IPB–CMA bills MCP for ACT SRV´ for plan members or "ACT provider bills appropriate ACT Rate Code" for FFS (fee for service) members.
14 Claims for members that do not have pre–loaded acuity scores loaded into the system are pended for 60 days. Does that mean that claims for members without pre–loaded acuity scores are delayed for 60 days? When a claim is submitted to Medicaid for an adult member for a date of service (DOS) on or before 12/1/16 that does not have a Base or Adjusted Acuity score, the Health Home claim for that member is automatically set to a Pend status for up to 60 days. The Pend status does not apply to Health Home claims for members with acuity scores.

Periodically, DOH reviews the tracking system, identifies adult members with HH billing instances for DOS on or before 12/1/16 that do not have member specific Base or Adjusted Acuity scores, and loads the statewide average acuity score for those members in the MAPP Health Home Tracking System. The Medicaid billing system checks to see if the member´s acuity score has been loaded on a weekly basis. Once the acuity score has been loaded, the claim pays.

Please see the Information on Denied Health Home Claims document available on the Health Home website here.

This process will remain in effect for DOS through and including 11/2016. For dates of service on or after 12/1/16, payments for adult members are based on a member´s High, Medium, Low (HML) tiers of service need in the MAPP HHTS. For date of service on or after 12/1/16 payments for child members are based on the member´s CANs–NY completion tier. For payments that are made based on HML rates, providers should no longer see this delay, as the member´s acuity score will be ignored in the HML calculation if it has not been loaded (see question 1 for further clarification on how acuity scores affect billing rates). Downstream providers must ensure that the HML/children´s questionnaire questions are completed monthly for all their members and indicate that a core service was provided in order for billing and payment to occur.
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Consent (Adult and Child Members)
15 When do I need Consent for a child member? I am an adult HH, why is it saying I need Consent To Enroll to enter a child into my program? What consent type should I use on the consent upload file? Any member under 21 years of age that is being referred into the MAPP HHTS needs "Consent to Refer" in order to be entered into the MAPP HHTS via the Children´s Referral Portal. In order for a member to be entered into an Enrollment Segment, the member may or may not need Consent To Enroll based on the below rules:

If the member is 18–21 years of age and being served by an adult network HH, or a HH serving both (adults and children) that selected adult, Consent To Enroll is not required.

If the member is under 18 years of age and being served by an adult network HH, or a HH serving both (adults and children) that selected adult, Consent To Enroll is required. If a member is under 21 years of age and being served by a child network HH, or a HH serving both (adults and children) that selected child, Consent To Enroll is required.

Although not required from a MAPP HHTS perspective, Consent To Share is required from a policy perspective for all members in the MAPP HHTS. On both the screen and in the Consent Upload File, three types of consent are available – Consent To Enroll, Consent To Share, and Consent To Share (Protected Services). A member can have up to all three of these Consents at once. If a member that you are working with has more than one Consent, you would enter each Consent type as a separate create consent line in the upload file. For example, if the member you are working with has a Consent To Enroll and Consent to Share Information, you would include two lines for that member on the Consent Upload File even if both Consents were signed by the same consenter at the same time.
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Converting Programs
16 If a Health Home assigns a new Health Home member to a converting care management agency (a former OMH TCM, COBRA, or MATS provider), can the Health Home (if the member is FFS)/Managed Care Plan (if member is enrolled in MC) bill for this member at the Health Home rate? For dates of services on or before 11/30/16, converting OMH TCM, COBRA, and MATS care management agencies were responsible for billing Medicaid directly for ALL of the Health Home services they provide to both existing and new members under the Health Home rate codes (1386/1387 or 1800 series). Health Homes/Managed Care Plans cannot bill for members listed in the tracking system with a value of "Y" in the Direct Biller Indicator field.

For service dates on or after 12/1/16 converting providers will no longer direct bill for Health Home services. Payment for Health Home care management services provided will follow a downstream flow from either the HH (for fee–for–service members) or the Managed Care Plan (for MCP members). For dates of service on 12/1/16 until MCPs are ready to accept 837I claims HHs will bill for all members, FFS or MCO. During this time MCO are working on updating their billing system to be able to accept the 837i claims format from HHs. The only exception to this is that MCOs can bill for ACT services for members that are in a Medicaid Managed Care Plan and CMAs can bill eMEDny directly for ACT services for FFS members.

Health Home billing rates will be determined based on the monthly HML billing assessment completed by the care management agency and input into the MAPP HHTS.

Any claims not submitted by 12/1/16 with service dates prior to 12/1/16, should be submitted by the legacy provider, MCP for non–converting providers serving MCP members, or the HH for non–converting providers serving FFS members under the 1386/1387 or 1800 series rate codes.
17 Do converting programs have to figure out which claims to bill under their legacy rate codes (1800 services) and the Health Home rate codes (1386/1387) or does DOH figure that our when the claims are submitted? For Health Home claims with dates of service on or before 11/1/16 converting programs are responsible for determining which members should be billed under each set of rate codes (legacy vs. Health Home), submitting claims with the appropriate rate codes, and staying under their legacy cap. There is no edit in the system that will tell a converting provider that they have billed too many claims under the legacy rate. If a converting provider bills in excess of their legacy cap in a given month, that converting program is responsible for going back and resubmitting those excess legacy claims under the 1386/1387 Health Home rate codes.

Beginning on 12/1/16 converting providers will no longer direct bill and will use the HML assessment within the MAPP HHTS to determine rates for each member.
18 I am a converting care management agency and can bill 50 claims each month under the legacy rate codes. Last month, I billed 84 Health Home claims, 50 under the Health Home rate codes and 34 under the legacy rate codes. One of the claims submitted under the legacy rate code was denied. How do I make sure that I get paid of all 50 legacy claims each month? For Health Home claims with dates of service on or before 11/1/16 each converting provider can bill a specific number of Health Home claims under their legacy 1800 series rate codes each month and then bill any remaining Health Home claims under the 1386/1387 rate codes. If a legacy claim submitted under the 1800 series rate code is denied, the converting provider may adjust a claim that was previously submitted under the 1386/1387 rate codes and resubmit that claim under the 1800 series rate codes, as long as that converting provider is not exceeding their monthly legacy rate cap.

Beginning with service dates on or after 12/1/16 converting providers will no longer bill directly. Legacy codes and Health Home rate codes will be converted into the HML rate codes. Rate code amounts will be based on the responses to the HML questionnaire within the MAPP HHTS.
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Member Assignment
19 My Health Home received assignments for members that live in counties that we are not officially covering. Can we provide services to a member that does not live in the counties that we cover? Health Home assignments are based on a member´s service connectivity to a Health Home´s network of providers. Health Homes can provide Health Home services to any member as long as they can adequately provide Health Home services, regardless of the member´s county. It is up to each Health Home to decide which members the Health Home can adequately serve. If a Health Home decides to reject a member based on where the member lives, the ideal next step would be for the Health Home to reject with a reason of "Member not in Service Area". This will indicate to the MCP that they should reassign to a different Health Home.
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Member Assignments/ Referrals
20 I have not received assignments/referrals from a Managed Care Plan I am working with. What should I do? Managed Care Plans assign their HH eligible population to downstream providers using online functionality or by uploading assignments into the MAPP HHTS. These assignments are then included in the assignment files that Health Homes download from the MAPP HHTS; alternatively, Health Homes can view their assignments on the My Assignments screen within the MAPP HHTS. If you are concerned that you have not received member assignments from a Managed Care Plan you are working with, please contact the Managed Care Plan.

Managed Care Plan Contacts for Health Homes

With the advent of the children´s program MCPs will also receive a higher volume of referrals. It is imperative that MCPs assign members to downstream providers in a timely manner. As a children´s HH or CMA if you are in contact with the member and plan to work with the member you should refer the member directly into an outreach or enrollment segment with your organization by answering yes to the question asking if you are engaged in communication with the member. This will ensure that the member remains assigned to you. Should you accidently fail to do this it is necessary that you contact the member´s MCP and request that the member be assigned back to your organization, otherwise there is a high probability that the MCP will assign the member to a different organization.
21 What is the difference between a "Pending" Assignment and a "Pending" Referral? All Assignments have a record type. There are three Assignment record types that are used to describe why/how an Assignment was created: Assignment, Referral, and Transfer. All "Pending" Assignments and Referrals should be assigned to a downstream Provider for Outreach or Enrollment services in a timely manner.

An Assignment with a "Referral" record type is an Assignment that was created through the Children´s Health Home Referral Portal. Since members under 21 must be entered into the MAPP HHTS using the Children´s Referral Portal, just about all* Assignments for members under 21 will have a "Referral" record type.

An Assignment with an "Assignment" record type is an Assignment that was either sent to an MCP by DOH OR sent directly to a Health Home by an MCP or DOH.

An Assignment with a "Transfer" record type means that another HH wants to send a member´s Enrollment Segment to your HH. If you accept an Assignment record with a "Transfer" record type, the MAPP HHTS will open a new window to collect Enrollment/Consent information from you. Once you complete that process, the MAPP HHTS will end date the other HH´s Enrollment Segment/Consent with that member and create an Enrollment/Consent record with your HH.

*The definitions above only apply when an Assignment is created for a member newly submitted into the MAPP HHTS. As a member moves in and out of Segments within the MAPP HHTS, the member´s Assignment record type may change.
22 For Children, is it possible for the HH to batch upload a list of children that may be HH Eligible into the MAPP HHTS, assign them to a CMA and have the CMAs complete the Children´s Referral Screen? OR For children, can they only be enrolled via the Children´s Health Home Referral process? Children that are under 21 AND do not currently have an Assignment with your HH in the MAPP HHTS must be manually entered into the MAPP HHTS using the Children´s Health Home Referral Portal. The only situation where a HH user can enter a member under 21 into the MAPP HHTS outside of the Children´s Referral Portal is if that member is already assigned to the HH and the HH enters a Segment for that member using the Tracking Segment file.
23 When we process Referrals and assign ourselves as a client´s health home it sounds like we also have to go in and accept the Assignment/Referral. Is that correct? If you create a Referral without putting the member into an Outreach or Enrollment Segment, you are unable to assign a HH. The member would go to either the member´s MCP (for MCP members) or to a HH based on the DOH´s recommended HH lists (for FFS members). If the member goes to the MCP, you could ask the MCP to assign the member to your HH. If you would like to continue to work with the member, you should wait until you are able to put the member into either Outreach or Enrollment when creating the Referral to ensure you will have a connection within MAPP HHTS with the member.
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Member CIN Search
24 In the HH Worker user manual, the CIN search download file can be used to download up to 1000 CINs from the search. Is there any way to search more than 1000 CINs at once? There is not a way to search more than 1000 CINs at one time in the Member CIN Search. As a reminder, the Member CIN Search is used to search for members that may or may not be associated with your Organization. For members associated with your Organization, you can use the My Members download file. This file will show all members who are assigned or have a current Segment with your Organization and is not limited to 1000 members. Alternatively, you can submit a second query when using the Member CIN Search. For example, if you would like to search for 1500 members you can first create a query to search for the first 1000 members, then create a second query to search for the last 500.
25 If a member does not have coverage currently, but did formerly, will they show up in the CIN search results? When using the Member CIN Search, a member who is currently not eligible will show up but you will be able to see the Medicaid end date, displayed in the third column under the member search, to determine eligibility. MAPP HHTS can have up to a week lag in receiving information from ePACES. The most up to date information regarding a member´s eligibility and coverage can be found in ePACES.
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Member Records
26 (New Evidence) Is there a bulk change option if a MAPP HHTS user identifies an address change for multiple beneficiaries? No, but a MCP worker can use the MCP Final HH Assignment File to bulk upload member contact and language information. Health Home and CMA users cannot bulk upload member address information but can change addresses individually under the member´s home page in the MAPP HHTS.
27 (New Evidence) When creating a secondary address, what if the person is homeless? Please use either the comments or the notes feature if you would like to document within the MAPP HHTS that a member is homeless. A user can add a note by going into the personal information tab within the member´s home page and clicking the "Action" button next on the address line to open the note box.
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Other/General Questions
28 Is the Acuity of the child determined by the CANS–NY Assessment or the MAPP HHTS output? The monthly Health Home rate for members under 21 that are working with a Health Home serving children is determined by the member´s most recently completed "Active" CANs–NY Assessment. If a member that is under 21 was identified as Health Home eligible by DOH using historical claims and encounter information, then that member will contain a base acuity score in the MAPP HHTS. However, the base acuity score for a member that is under 21 that is working with a Health Home serving children will not factor into the monthly rate determination for that member since that member´s rate is purely based on the member´s most recently completed active CANs–NY Assessment. If a child member who is under 21 is being served as an adult and has a base acuity score, this information will be used when the HML rate is calculated for this member. This is one of several factors that is used when determining the HML rate. If the member does not have a base acuity score, this field is ignored and all other HML Assessment questions are used to determine the appropriate HML rate for the member.
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Outreach/Enrollment Segments
29 Can you create an Outreach Segment using the Adult Referral Wizard for an adult member assigned to another HH/CMA? You can use the Adult Referral Wizard to create an Outreach or Enrollment Segment for an adult member who has an "Active" or "Pending" status with another HH, but if the adult member currently has an "Active" Segment with another HH or CMA, you will not be able to due to overlapping Segments.

Scenario 1: HH 1 has an "Active" Assignment with an adult member, but no "Active" Segments. HH 2 uses the Adult Referral Wizard to create an Outreach Segment. HH 2 will get a warning message that the adult member has a relationship with HH 1, but no "Active" Outreach or Enrollment Segments and will be able to complete the Referral. The adult member will be removed from HH 1´s Assignment file. HH 2 will have an "Active" Assignment and an "Active" Outreach Segment.

Scenario 2: HH 1 has an "Active" Assignment with an adult member and an "Active" Segment. HH 2 uses the Adult Referral Wizard to create an Outreach Segment. HH 2 will not be able to complete the Referral and will get a warning message that the adult member has an "Active" Segment with HH 1. The adult member will remain on HH 1´s Assignment file and continue to have an "Active" Segment with them.

Scenario 3: MCP 1 has a "Pending" or "Active" Assignment with a child member. HH 1 wants to start working with a child member that they have been in contact with. HH 1 attempts to enter the member into a Segment using the Children´s Referral Portal but receives a warning message that the member has an Assignment with MCP 1. In this case, HH 1 should contact MCP 1 and request that the MCP assign the member to their HH.

*Note: A user cannot make an Outreach or Enrollment Segment using the Children´s Health Home Referral Portal if the child member has an association ("Pending" or "Active" Assignment or "Active" Segment) with a HH organization in the MAPP HHTS.
30 When a MAPP HHTS user modifies an Enrollment Segment end date, will another HH´s Segment get rejected due to the creation of an overlapping segment? How does this process cease if another HH provides future services? Two Segments cannot exist at the same time. Typically, when you modify an Enrollment Segment, you would be end dating the Enrollment Segment at the time you determine the Enrollment is ending, therefore, you would not have an issue of overlapping Segments (as no other segment exists at this time). If HH 1 had an Enrollment Segment that ended on 5/31/16, for example, and HH 2 started a Segment on 6/1/16, then HH 1 attempts to go back and modify the end date to 6/30/16, HH 1 would get an error message and not be able to modify the Segment. There would be no effect on the Segment HH 2 started on 6/1/16.
31 Can a new Enrollment Segment be created with a different CMA (CMA 2) if the member is "dissatisfied with the current service," but still has an "Active" Enrollment Segment with the first CMA (CMA 1)? No, a member can only have one "Active" Segment in the MAPP HHTS at any given time. In this case, CMA 2 would need to work with CMA 1. CMA 1 would need to end their Segment on the last day of the month preceding the month CMA 2 would like to begin their Segment. We suggest doing this via a phone call from one Organization to the other.
32 How does a "Pending" Enrollment affect billing when a pend start date is in the past? What if work has been done for most the month, but the pend start date indicated was the beginning of the month? If you enter a pend start date for a Segment that is in the past, the MAPP HHTS will automatically end date the "Active" Segment with the last date of the month preceding the "Pended" Segment start date. When you or the billing entity downloads the next billing support file, you would see this via the "V" in the Add/Void indicator field. The billing entity should use the file to rectify any records that were submitted in error. If a core service has been provided during the service month, and the member´s Segment then needs to be "Pended" towards the end of the service month, the first day of the following month can be utilized as the "Pend Start Date".
33 There is an End Date reason code of "invalid reason code at conversion". How should this message be interpreted? There are new edits in the MAPP HHTS that were not in the old system. When a Segment entered in the old system is converted into the MAPP HHTS and it hits one of these edits, the user will receive this end date reason code.
34 When creating Outreach or Enrollment Segments in the MAPP HHTS, will the Children´s Heath Home have to accept a Segment after the CMA enters the member´s information into the Children´s Referral Portal? (i.e., will they be pending the HHs approval after completing the Children´s Referral Portal. Some CMAs are VFCAs in NYC and have the same role as the LDSS in ROS.) When a VFCA CMA creates a Segment in the MAPP HHTS, whether the Segment is created within the Children´s Referral Portal, online, or using a file, the created Segment will not go to the "Pending Active" status; it will go directly to the "Active" status. This means that a HH does not accept Segments created by VFCA CMAs.

Non–VFCA CMAs would see a Segment go into a "Pending Active" status, if they do not have auto–approval set up when creating a Segment within the Children´s Referral Portal, online, or using a file. A Non–VFCA CMA would see a Segment go into an "Active" status if they do have auto–approval set up with the HH when creating a segment within the Children´s Referral Portal, online, or using a file.
35 Does the Billing Assessment (Children´s Questionnaire) need to be completed during Outreach? The MAPP HHTS will automatically generate the correct questions under the Assessments tab, Children´s Questionnaire inner tab based on the members Segment status. Likewise, the MAPP HHTS user can follow the logic outlined in the File Specifications Document to answer the correct questions based on Segment type in the Billing Support Upload file. The Questionnaire must be answered during "Active" Non–Hiatus Outreach and Enrollment Segments.
36 Why would you delete an Enrollment if the status is "Pended"? Why not deactivate? Why not modify the start date? Does it cause multiple lines on the Enrollment file? Did the client have activity as a "Pending" status? If so, how does that work in the MAPP HHTS? MAPP HHTS does not allow an Enrollment Segment to be deactivated or for a user to modify the start date of the Segment once the Segment has been created. The delete option within the MAPP HHTS indicates that a Segment was created in error. A Segment should only be deleted if the Segment should have never been created. Deleting a Segment will create a "Canceled" status in the MAPP HHTS.

Pending a Segment allows the User/Organization to continue to retain the member while they are currently unable to work with the member. For example, a member may become incarcerated for a period of time. During incarceration, a member looses their Medicaid coverage and, therefore, is not eligible for HH services. Upon release from prison, the same HH plans to continue to provide services to the member and will then put the member back into an "Active" Enrollment Segment. The client typically is not receiving services while their Segment is in a "Pended" status. Organizations are unable to bill for a member that has a "Pended" Segment status unless the pend reason is that the member is in an inpatient facility (per HH program policy). Each Segment status (active, pended, etc.) will appear as a separate line on the Enrollment file unless the pend reason is that the member is in an inpatient facility (per HH program policy).
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Relationships
37 How does a HH get connected to a CMA MAPP HHTS? If you already have a completed and approved Business Associate Agreement (BAA) and have received an approval letter from DOH Privacy office, you will need to submit a copy to mapp–customercarecenter@cma.com.

You MUST include the MMIS provider IDs for both organizations when submitting a request to add a relationship in MAPP HHTS. If you do not have an approved BAA you can´t be connected in MAPP HHTS. If you do not have a copy of the approval in your records but know it was approved, you can still submit a request to MAPP CCC and DOH will request the documentation from the DOH Privacy Office.
38 How Does a MCP get connected to a HH in MAPP HHTS? If you already have a completed and approved Administrative Health Home Services Agreements (ASA) with a HH and have received an approval from Bureau of Managed Care Certification and Surveillance, you will need to submit a copy to mapp–customercarecenter@cma.com.

You MUST include the MMIS provider IDs for BOTH organizations when submitting a request to add a relationship in MAPP HHTS. If you do not have an approved ASA you can´t be connected in MAPP HHTS. If you do not have a copy of the approval in your records but know it was approved, you can still submit a request to MAPP CCC and DOH will request the documentation from the Bureau of Managed Care Certification and Surveillance.
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Restriction/Exception (R/E) Codes
39 Does the MAPP HHTS offer a list of R/E Codes? Where would I obtain this information? There is a list of R/E codes posted on the DOH Health Homes website here.
40 I´ve provided Care Management to a member and received a denial because I did not realize the member had an invalid coverage code / R/E code / not Medicaid eligible / working with another Provider, etc. Why is this member on my Assignment file and can I get paid for this member? A requirement of the Health Home (HH) program is that all Providers (CMAs and HHs) first check a member´s Medicaid eligibility and confirm that the member´s R/E and Coverage codes are compatible with the HH program (please see links below for R/E and coverage code information). In addition, the Provider must look up the member´s HH status using the Member CIN Search function in MAPP HHTS to see if the member has had any recent Care Management claims. If the member has recent Care Management claims, you must contact the other Care Management Provider to see if they are still working with the member.

R/E Codes

Coverage Codes

Additionally, Medicaid members with Principal Provider codes of AL and NH are not eligible for Health Home Care Management. Currently, the MAPP HHTS will not prevent a member from having a Segment entered into the system if they have a Principal Provider that is not compatible with the Health Home program. As a reminder, Providers are required to verify Medicaid eligibility for all members prior to creating a Segment. Any member that you are working with must be in MAPP HHTS. It is not enough to simply put the member into your own internal system. You must confirm that this information is updated in the MAPP HHTS on a regular and frequent basis. If you are a CMA and your HH submits this information to MAPP HHTS for you, you must ensure the information is submitted in a timely manner. As a CMA, you are responsible for verifying (1) the member is HH eligible before working with the member and (2) the member is reported in the MAPP HHTS. MAPP HHTS is considered the source of truth for the HH program. Members may be on Assignment files that were once eligible for the HH program. MCPs may reassign the member to a downstream Provider without realizing that the member is no longer HH eligible. All member statuses can change from month to month, which is why it is imperative to check member information each month.

If a member does not meet the criteria to be eligible for the HH program, you may continue to work with them but you will not receive payment for HH services. Providers will not receive payment for denied Health Home claims because the member is not Medicaid eligible or the member has an R/E or coverage code that is not compatible with the HH program. Providers must check the member´s Medicaid eligibility, R/E and coverage code on a routine basis.
41 On the My Members screen, can you view a members R/E codes and members with inactive Medicaid? Are these fields on the My Members download file? The My Members screen does not display these results, nor does the My Members download file. This information can be found within the Member CIN Search.
42 I am trying to enroll a member and keep getting a message saying that coverage code or the R/E code is not compatible with the Health Home program. What does this mean? Within Medicaid, all members have a coverage code that describes a member´s Medicaid coverage. Some members may have an R/E code. This stands for restriction exemption. Some Medicaid coverage codes or R/E codes only cover certain services and other codes indicate a member is eligible or enrolled in Care Management services outside the Health Home (HH) program. The member´s coverage and/or R/E code may or may not be compatible with the HH program. When an R/E code indicates that the member receives Care Management services under a different program, the member will not be eligible for both that program and the HH program.

List of coverage codes and their compatibility with HH program

list of R/E codes and their compatibility with the HH program

Within each of these links, you will see notes indicating if a certain coverage or R/E code is/is not compatible with the Health Home Program. If a member´s coverage or R/E code are listed as incompatible with the Health Home program as of the date you attempt to begin a Segment, the MAPP HHTS will reject the Segment and, in most instances, the Health Home claim for that member will not be paid by Medicaid. When attempting to enter a Referral for a member with an invalid R/E code, you will receive the following message: "The member´s R/E code is not compatible with the Health Home Program ". When attempting to enter a Referral for a member with an invalid coverage code you will receive the following message: "The member´s Coverage Code is not compatible with the Health Home Program ".

You should use the Member CIN Search to look at codes for a member before working with the member to determine their eligibility. Some R/E codes (such as R/E 30) indicate a member is eligible for either the HH program or a different case management service through the Long Term Care Waiver Program. When a member has this R/E code you will still be prevented from entering a Referral for the member. In this case, both programs should be thoroughly explained to the member so that the member can determine which program is most appropriate for their needs. If the member determines that the HH program meets their needs most appropriately, the member would need to contact their LDSS and speak with the person who consented them into the waiver program and express their desire to no longer be part of the waiver program and that they want to enroll in the HH program. The LDSS representative will remove the coverage code and the HH will be able to enroll the member in the HH program. Please note that some Long Term Care Waiver R/E codes (i.e. R/E 60) that are an either/or situation are for members who have recently been discharged from long term care so these codes may be valid even if the member is not in a long term care setting.
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Roles
43 How does my organization get a new MAPP Gatekeeper? If you already have a MAPP HHTS Gatekeeper for your organization, your current Gatekeeper can add/remove additional gatekeepers. We encourage each organization to have two Gatekeepers due to employee turnover. If you do not have a gatekeeper or your assigned gatekeeper no longer works for your organization, you will need to submit the "MAPP Gatekeeper Add or Remove Form" to mapp–customercarecenter@cma.com. The form can be found here . The form must have all fields completed and include the HCS ID of new Gatekeeper and the organizations MMIS provider ID.
44 How does my organization add new staff to MAPP HHTS? Your organization´s MAPP HHTS Gatekeeper will need to sign into MAPP HHTS under the MAPP Gatekeeper role. They will be able to add and remove MAPP HHTS roles as needed. Each user must already have a HCS account under their organization. Once a MAPP HHTS role is added, MAPP CCC will contact the new user via the email address in MAPP HHTS with the training information. If you have a new role and did not receive training information after 2 days, please contact mapp–customercarecenter@cma.com.
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Tracking System
45 When an agency submits tracking files for their converting members, there are instances when an individual has had multiple admissions and discharges within the same converting program since the effective date of the SPA and now. Should the converting provider treat these multiple admissions and discharges as a single segment, single add/change record, with the earliest admit date and the most recent discharge date OR should each episode of care be separate with an Add record to begin, change record to dis–enroll in the first episode and then a new add record to admit for the next episode, change record to dis–enroll, etc. If it is to be a separate add/change per episode, can all episodes be included in the same file submission? All Health Home member enrollment segments must be submitted to the MAPP Health Home Tracking System. This means that each episode of care should be identified separately in the tracking system. If a segment´s end date is known when the initial Create "C" record type is submitted to the portal, it should be included on the initial add record.

In the situation outlined in the question, the Health Home should submit two Create "C" records: one containing the begin date and the end date of the first enrollment period and the second one containing the begin date of the second period.

All of these record submissions, as long as the segments do not overlap, can be submitted together in one Tracking File Segment Record. It is important to ensure that the records are properly sorted when submitting multiple records for the same member within the same file.

For more information on submitting files to the tracking system, please see the Specifications Document
46 For Health Home member tracking file purposes, how far back should converting providers go to account for members in the member tracking system? Converting programs must submit tracking file information for all of their members going back to the begin date of their phase (phase 1: 1/1/12, phase 2: 4/1/12, phase 3: 7/1/12).
47 According to the Tracking System Specifications document, the system automatically end dates outreach after 3 months. Do we then have to put in a begin date of outreach after that 3 month hiatus period or will the system know to do that if there is no Opt–out date? The MAPP HHTS will automatically calculate the hiatus segment if no end date is included when an outreach segment is added to the system. After 3 months of hiatus the member´s outreach hiatus segment will be automatically closed. If the user inputs an end date into the original active outreach segment, the system will be unable to begin an outreach hiatus upon the end date of the active outreach period. Because of this users should never end date an outreach or outreach hiatus segment if at all possible.

The system is unable to process a user–provided end date for an outreach hiatus segment because the user is unable to select the correct systems reason of Hiatus to Close. Therefore, a user should never enter an end date for an outreach hiatus segment. If a user needs to end an outreach hiatus segment (i.e. their organization or another organization has been in contact with the member and would like to enroll the member) the user must delete the outreach hiatus segment with a segment end date reason of "Hiatus to Closed" instead of modifying and putting in an end date. By deleting the outreach hiatus segment, the user/another user can now create the enrollment segment.
48 I submitted a record to the Tracking System that was rejected because the member was not Medicaid Eligible, but according to ePaces the member is Medicaid eligible; how should I proceed? Before beginning any outreach or enrollment segment a user should use the member CIN search to check the member´s eligibility. Included in this information are any coverage codes and R/E codes that may or may not deem a Medicaid Member ineligible for the HH program. A complete list of these codes can be found:

Coverage codes

R/E codes

It is important to note that this information comes from ePACES but there can be up to a week lag in this information being updated into the MAPP HHTS. The source of truth regarding a member´s eligibility is ePACES.

Anytime a record is rejected from the MAPP Health Home Tracking System because the member is not Medicaid eligible, the first step is to check ePACES to confirm that the member is Medicaid eligible as of the begin date on the record. If a member is not Medicaid eligible as of the begin date on the record, the member is either not eligible for the Health Home program since the member is not Medicaid eligible or the member´s begin date in the record needs to be adjusted to when the member´s Medicaid eligibility began. Furthermore members that are referred into the system using the Children´s Referral Portal must be eligible as of the date the referral is being created, regardless of the segment start date. If the member on the rejected record is Medicaid eligible as of the begin date of the record, put the rejected record aside and try resubmitting the record in a week. If the record is rejected the following week, continue to resubmit the record each week for at least four weeks. If the record continues to be rejected after that, submit a ticket to MAPP CCC with the issue and the File IDs of the files with the rejected records.

If an adult member is not Medicaid eligible in ePACES due to a lag in recertifying with DSS/the exchange and you would like to enroll the member and help them re–instate their Medicaid eligibility you can use the adult referral wizard quick link to put the member into the system. You will receive a warning message but will be able to proceed. If the member´s eligibility is reinstated retroactively and covers the period of time you are working with the member you would be able to bill for this period, but if Medicaid coverage isn´t obtained you would not be able to bill during this time period for the member as the claim would be denied. Child members (members under 21, regardless of how they are being served) cannot be referred into MAPP HHTS or a segment be created via the Children´s Referral Portal until the member has regained Medicaid eligibility.
49 I submitted a record to the Tracking System that was rejected because the member´s gender or DOB (date of birth) was incorrect, but according to ePaces, the gender or DOB I submitted is correct; how should I proceed? Anytime a record is rejected from the Health Home Tracking System because the member´s submitted gender or DOB does not match the gender or DOB on file with Medicaid, the first step is to confirm in ePACES that the gender or DOB submitted is in fact correct. If you learn that the member´s gender or DOB is listed incorrectly in ePACES, assist the member in correcting the information with the local DSS office or through the NY State of Health. You must submit the incorrect gender or DOB to the Tracking System until the gender or DOB is updated in ePACES. The MAPP HHTS checks the member´s DOB and gender against the information found in ePACES. The MAPP HHTS can have up a week lag in information from ePACES and therefore a record containing the same DOB and gender listed in ePACES could be rejected if information had been recently changed. If a record is rejected even though it contains the gender or DOB that is currently listed in ePACES, put the rejected record aside and try resubmitting the record in a week. If the record is rejected the following week, continue to resubmit the record each week for least four weeks. If the record continues to be rejected after that, submit a ticket to MAPP CCC with the issue details.
50 We have a member that we provided outreach services for in January and February. Upon our outreach we discovered that the member was Spanish speaking so we had to send him to our Spanish speaking downstream provider. I ended the member on our tracking file with an end reason code of 03 (Changed Care Management Agency) and an end date of 2/28/14. Our downstream provider added the member on their March tracking file with a start date of 3/1/2014. When I submitted the tracking file it was rejected with an error code of 029 (Most recent Outreach within 3 months). I was just wondering why I am getting the error code and if I am ending and submitting the tracking files correctly? Anytime you split a member´s outreach segment between two Care Management Agencies, you need to submit the appropriate end date when adding the member to the new CMA to ensure that the member only gets three months of active outreach.

For example, John Doe received outreach services from CMA 1 from Jan – Feb 2014. In March 2014, CMA 2 provided outreach services for John Doe. To properly submit this information to the tracking system, you´d first need to submit an add record for John placing him in the outreach status with CMA 1 with a begin date of 1/1/14 and an end date of 2/28/14. You then need to submit an add record placing John with CMA 2 in the outreach status with a begin date of 3/1/14 and an end date of 3/31/14, ensuring that the member only gets three months of outreach services from the Health Home (Jan – March 2014). If you do not include the appropriate end date on the second segment, then the system will automatically end date the second outreach segment on 5/31/14 (three months after the begin date), which would place the member in outreach for more than the allowable three months and therefore the record would be rejected. Please note the system looks at total amount of outreach the member had, not which organization provided outreach, therefore the 3 in 6 months rule is member specific, not provider specific.
51 As the Health Home programs continue to expand, it is becoming a very onerous and time consuming effort to look up lists of members (at times over 1,000) one by one in the Health Home Tracking System Portal Member Search Function. Is there a near–term or interim technology solution that could be used to quickly process member lists, such as a batch look up process? In the MAPP HHTS up to 1000 members can be searched through the Member CIN Search screen for using the screen functionality by copying and pasting the CINs into the CIN search field, although only 20 CINS will display on the screen the user can download a file containing up to 1000 CINs.

Other screens also contain download functionality that may be helpful when looking at your specific members. Please reference your end–user guide for more information.
52 My Health Home doesn´t have a relationship with a MCP that a few of my members belong to since these members were converted in from the old system. The MCP doesn´t assign members to us on a regular basis. What do we do? For instances where the member is enrolled with a MCP that you don´t have a relationship with, your HH and the MCP should ideally work together to develop a legal agreement to share information (an Administrative Services Agreement ). This does not mean that the MCP would be required to start assigning members to your HH, instead this legal agreement would just cover certain situations so that a member would be able to stay with the MCP and HH of their choosing and not have to make a decision to switch. When an Administrative Services Agreement cannot be developed a non–provider agreement will suffice in instances where the Health Home is only serving a few members from a MCP.

Legal agreements should be sent to DOH by the MCP (through a MAPP CCC ticket ) so that relationships can be established within MAPP HHTS. Use the web form to request this under the subject Medicaid Analytics Performance Portal (MAPP).

HHs should review their members and relationships and ensure they have the appropriate relationships set up.

Please reference slide 6 for more information
53 How will vendors access MAPP? MCP, HH, and CMA providers are responsible for enrolling their own users into MAPP. As long as vendors are properly set up with HCS access, organizations will be able to enroll vendors into MAPP.

OPTIONS 1) Vendor is not set up in HCS–The HH may work with the vendor to set up HCS user accounts for the vendor staff and assign appropriate MAPP Roles to the vendor staff. In this option, the vendor staff will essentially operate as HH employees. If staff are terminated or leave employment, the vendor must notify the HH so that the HH can delete the HCS user account and update its records.
2) Vendor is set up in HCS–The vendor will ensure that its staff have a HCS user account. The vendor will provide the HH with the name, HCS user id, and MAPP role of vendor staff who will work with the HH. The HH will assign the appropriate MAPP role to vendor staff. If staff are terminated or leave employment, the vendor will delete the HCS user account.
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