REFERENCE FILE APPLICATIONS

The REFERENCE subsystem serves as the repository for all information on procedures, diagnoses, drugs, and diagnosis related groups (DRG), exception codes, rates, and prepayment utilization review criteria used to control the processing and payment of medical claims.

The REFERENCE subsystem also maintains text information used for provider and recipient letters.

The table below is the MMIS MAIN MENU-MAIN. Remember, menu items will vary depending on security group assigned to worker.

Table of the MMIS MAIN MENU - MAIN panel 
                                MMIS MAIN MENU - MAIN   ATST    C101    
               ***   MEDICAID MANAGEMENT INFORMATION SYSTEM   ***               
 SEL                                     SEL                                    
    CLAIMS PROCESSING APPLICATIONS:                                             
     INQUIRY                                                                    
    REFERENCE FILE APPLICATIONS:                                                
     PROC, DRUG, DIAG, DRG, UPC                                                 
     RATES                                                                      
  x  TEXT                                                                       
    PRIOR AUTHORIZATION APPLICATIONS:                                           
     PRIOR AUTHORIZATION                                                        
     SCREENINGS                                                                 
    OTHER APPLICATIONS:                                                         
     PROVIDER FILE APPLICATION                                                  
     RECIPIENT FILE APPLICATION                                                 
     TPL BILLING APPLICATION                                                    
     FINANCIAL CONTROL                                                          
     TPL RESOURCE FILE APPLICATION                                              
     RECIPIENT MISCELLANEOUS FUNCTIONS                                          
                                                                                
                                                                                
 ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
                    S/EXT             N/EXT                    OOPS

How to use the REFERENCE FILE APPLICATIONS

  1. The key panels for each of the reference files allow workers to look up information about specific codes used in MMIS.
  2. The TEXT file contains descriptive text for exception codes or edits. In the example above edit TEXT is selected.
  3. Not all workers access reference files directly. Function key F4 navigates to the reference file from within a document and for most business needs, navigating using F4 is more efficient for looking up information about a code or rate in the reference files.
  4. In this course we will not go into further detail about looking up information directly in the REFERENCE file.

On the next page we will learn about navigation related to edits.

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