MMIS TYPE B HOME CARE SERVICE AGREEMENT - ASA1 AND ASA2

The ASA1, ASA2 and ASA3 panels are the same for the Type B Home Care service agreement and the waiver service agreement.

The first panel of a Type B Home Care service agreement (SA) is the ASA1. The table below is an approved Type B SA. To know if this Type B SA is for Home Care, PCA or CSG program the worker must review additional screens.

The second panel of a Type B Home Care SA is the ASA2.

The Type B SA queue screens are ASA1, ASA2, ASA3, AHC1, AHC2, AHC3, ADHS, APRV AND ARCP.

In this table MMIS fields are populated with sample data to show how MMIS fields appear with valid values entered. Field entries containing Protected Health Information (PHI) appear as zeros in this example.

Table of MMIS SERVICE AGMT - ASA1 panel 
 NEXT: ASA2                   MMIS SERVICE AGMT - ASA1  
                   AUTHORIZATION NBR: 0000 000 0 000                            
     AGMT STAT: A APPROVED                        CURR LOC/DT: 000        MMDDYY
     AGMT TYPE: B HOME CARE                 AGMT START/END DT: MMDDYY MMDDYY    
 PROV NBR/NAME:                                                  ASMT DT:       
  REF PROV NBR:              TOT AUTH AMT:   00000.00 CAP AMT:          
                        LAST           FIRST     MI                             
      RECIP NAME: LAST               FIRST       I   RECIP ID: 00000000  SEX: M 
   DOB(MMDDYYYY): MMDDYYYY     AGE:  00                    LA: 00   MAJ PROG: MA
     CM NBR/NAME:                                                               
       CO OF SVC: 000      CO OF RES: 000      CO OF FIN RESP: 000              
                  COUNTY              COUNTY                   COUNTY       
  DISC FUND(Y/N):          AUTH DATE:           AUTH SIG(Y/N): Y                
   SCH EVAL/TRMT:                                   MSG 1/2/3:                  
 DIAG RANGE 1 FR:                           DIAG RANGE 1 THRU:                  
 DIAG RANGE 2 FR:                           DIAG RANGE 2 THRU:                  
 AVG MO AUTH AMT:                          AVG DAILY AUTH AMT:                  
  TOT USED UNITS:                                TOT USED AMT:           
 LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID     
 01 274  6                                                                      
 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         OOPS

 

Table of the MMIS SERVICE AGMT - ASA2 panel 
 NEXT: ASA3                    MMIS SERVICE AGMT - ASA2  
                       AUTHORIZATION NBR: 0000 000 0 000                        
                                                                                
 AGMT TYPE/STAT: B A APPROVED    PROV NBR/TYPE:                                 
  RECIP NAME/ID: LAST              FIRST         I 00000000 SEX: M AGE/LA:  00 00
                                                                                
                                                                                
       STAT RSN:                           SEND RECIP LTR(Y/N): Y               
    ATTACH(Y/N): N                          SEND PROV LTR(Y/N): Y               
     SACTAD NBR:                                                                
                                                                                
        OVR LOC:                             AC PREMIUM AMOUNT:                 
                                PREMIUM EFFECTIVE DATE (MM/YY):                 
 CLAIMS UPDT DT: 061809                          PROV COMMENTS: Y               
    INPUT MEDIA: 0 EXAM ENTRY                   RECIP COMMENTS: Y              
 RESP PARTY(Y/N): N                               DHS COMMENTS: N               
 FISCAL INT(Y/N): N                 LIVES WITH RESP PARTY(Y/N): N               
   EXCLUDED TIME:      RESP PARTY NAME:             
 LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID     
 01 274  6                                                                      
 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         OOPS

The fields on the Type B Home Care service agreement ASA1 panel

All fields on the SA serve a purpose. The scope of this course does not include defining all fields. However there are a few fields that will be helpful to know when viewing a service agreement.

AGMT STAT field displays the status of the service agreement. A=APPROVED, D=DENIED, S=SUSPENDED, T=PARTIALLY SUSUPENDED, P=PENDED.

AGMT TYPE field displays the code and name of the service agreement type. Home care service agreements are type B.

AGMT START/END DT fields display the date span for this service agreement.

How to navigate the Type B Home Care service agreement

  1. In inquiry mode most MMIS fields are protected and worker is not allowed to enter data. Inquiry is used to view information in MMIS.
    • The NEXT field can be used to navigate to a specific panel by entering the acronym of the panel in the NEXT field.
    • TRANSMIT to advance to the next MMIS panel.
  2. In change and add modes some fields are protected and some fields are available for data entry. Some fields will be auto-populated by MMIS based on worker entries.
    • Add and change mode access to Type B Home Care service agreements is limited by security group.
    • TAB to available field. Any text in green may be updated. TAB will place cursor at available fields for entry. TAB past fields not needing completion.
    • SHIFT-TAB to go back to previous field.
    • Press HOME key to bring cursor to the top of the page.
    • The END key removes entire entry in a field. DELETE key removes entry one character at a time.
    • The ENTER (carriage return) key moves cursor down page one line at a time.
    • The NEXT field can be used to navigate to a specific panel by entering the acronym of the panel in the NEXT field.
    • TRANSMIT to advance to the next MMIS panel.
  3. In all modes function key F4 navigates to another subsystem to view information.
    • Place cursor on a field entry and press function key F4.
    • If F4 navigation function is available MMIS navigates to the subsystem requested.
    • On all panels from Recipient ID field F4 navigates to MMIS RECIP SUMMARY - RSUM panel.
    • From Case Manager and Provider number fields F4 navigates to MMIS PROVIDER SUMMARY - PSUM panel.
    • From Diagnosis code fields F4 navigates to MMIS DIAGNOSIS SCRN - FDI1.
    • From PROC field F4 navigates to MMIS PROCEDURE CODE1 - FPR1.
    • From edit number F4 navigates to MMIS PA/SA EXC RESLT - FPAT.
  4. To return to MMIS location (subsystem and screen) after F4 navigation was requested press F6.
    • F6 exits current screen and returns to previous screen.
    • Press F6 key only once to return to previous screen. MMIS will repeat exit function every time F6 key is pressed.
    • Function key F6 exits service agreement without saving. In change or add mode pressing F6 more than once could result in exiting service agreement without saving and entries will be lost.
  5. To exit and save data entered use function key F3. Use F3 key only when completely finished entering data and are ready to finalize document.

NEXT field on service agreement panels

  1. The NEXT field displays the acronym of the next panel in the Home Care SA queue. In this example ASA2 is displayed in the NEXT field.
  2. TRANSMIT to the ASA2 panel
  3. Worker may enter the acronym of another panel in the SA queue and TRANSMIT to that panel.

Now let's look at the ASA3 panel in the Type B Home Care service agreement.

    |