MMIS SERVICE AGREEMENT COMMENT PANELS

The waiver service agreement has three comment screens for entry of comments.

ADHS panel is for comments entered by DHS staff.
APRV panel is for comments to be included on the provider SA letters.
ARCP panel is for comments to be included on the recipient's SA letter.

The ARCP panel is the last panel in the service agreement queue. Pressing TRANSMIT from the ARCP panel returns to the ASA1 panel.

Table of the MMIS DHS COMMENTS - ADHS panel
NEXT: APRV MMIS DHS COMMENTS - ADHS AUTHORIZATION NBR: 0000 000 0 000 AGMT TYPE: J EW CONVRSN STATUS CD: A APPROVED PROV NBR: RECIP ID: 00000000 DHS COMMENTS LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID 04 274 F 0000000 274 RECIPIENT IS ELIGIBLE FOR MEDICARE. YOU NEED TO CHECK WHETHER THESE SERVICES ARE PAID BY MEDICARE. ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12 PAGE HELP S/EXT NAVIG SLIST N/EXT PREV NEXT

Table of the MMIS DHS COMMENTS - ADHS panel

 NEXT: APRV                   MMIS DHS COMMENTS - ADHS  
                       AUTHORIZATION NBR: 0000 000 0 000                        
 AGMT TYPE: J EW CONVRSN                                                        
 STATUS CD: A APPROVED    PROV NBR:            RECIP ID: 00000000               
                                 DHS COMMENTS                                   
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
 LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID     
 04 274  F 0000000                                                              
 274 RECIPIENT IS ELIGIBLE FOR MEDICARE.  YOU NEED TO CHECK WHETHER             
     THESE SERVICES ARE PAID BY MEDICARE.                                       
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12 
 PAGE  HELP        S/EXT NAVIG SLIST N/EXT PREV  NEXT

Table of the MMIS PROVIDER COMMENTS - APRV panel
NEXT: ARCP MMIS PRV COMMENTS - APRV AUTHORIZATION NBR: 0000 000 0 000 AGMT TYPE: J EW CONVRSN STATUS CD: A APPROVED PROV NBR: RECIP ID: 00000000 PROVIDER COMMENTS LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID 04 274 F 0000000 274 RECIPIENT IS ELIGIBLE FOR MEDICARE. YOU NEED TO CHECK WHETHER THESE SERVICES ARE PAID BY MEDICARE. ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12 PAGE HELP S/EXT NAVIG SLIST N/EXT PREV NEXT

Table of the MMIS PROVIDER COMMENTS - APRV panel

NEXT: ARCP                    MMIS PRV COMMENTS - APRV   
                       AUTHORIZATION NBR: 0000 000 0 000                        
 AGMT TYPE: J EW CONVRSN                                                        
 STATUS CD: A APPROVED    PROV NBR:            RECIP ID: 00000000               
                               PROVIDER COMMENTS                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
 LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID     
 04 274  F 0000000                                                             
 274 RECIPIENT IS ELIGIBLE FOR MEDICARE.  YOU NEED TO CHECK WHETHER             
     THESE SERVICES ARE PAID BY MEDICARE.                                       
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12 
 PAGE  HELP        S/EXT NAVIG SLIST N/EXT PREV  NEXT

Table of the MMIS RECIPIENT COMMENTS - ARCP panel
NEXT: ASA1 MMIS RCP COMMENTS - ARCP AUTHORIZATION NBR: 0000 000 0 000 AGMT TYPE: J EW CONVRSN STATUS CD: A APPROVED PROV NBR: RECIP ID: 00000000 RECIPIENT COMMENTS LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID LI EXC ST USER ID 04 274 F 0000000 274 RECIPIENT IS ELIGIBLE FOR MEDICARE. YOU NEED TO CHECK WHETHER THESE SERVICES ARE PAID BY MEDICARE. ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12 PAGE HELP S/EXT NAVIG SLIST N/EXT PREV NEXT

Table of the MMIS RECIPIENT COMMENTS - ARCP panel

 NEXT: ASA1                    MMIS RCP COMMENTS - ARCP  
                       AUTHORIZATION NBR: 0000 000 0 000                        
 AGMT TYPE: J EW CONVRSN                                                        
 STATUS CD: A APPROVED    PROV NBR:            RECIP ID: 00000000               
                              RECIPIENT COMMENTS                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
 LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID     
 04 274  F 0000000                                                              
 274 RECIPIENT IS ELIGIBLE FOR MEDICARE.  YOU NEED TO CHECK WHETHER             
     THESE SERVICES ARE PAID BY MEDICARE.                                       
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12 
 PAGE  HELP        S/EXT NAVIG SLIST N/EXT PREV  NEXT

How to use the comments panels

Comments are entered in text format on each of the comment screens.
There is no word wrap in MMIS so worker must tab to next line of text.
Comment panels hold 13 lines of text. There are no additional pages available.
Text on APRV and ARCP comment panels is included on the service agreement letters.

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