EXCEPTION CONTROL

The EXCEPTION CONTROL function in MMIS controls exception codes (edits) that post on documents. In this section of the course we will look at navigation related to edits.

The first table below is the ASA1 panel of a Type S service agreement for DD (Developmental Disabilities) Diversion (divert from nursing facility) waiver program. In this example there are edits posted on the SA.

The second table is the FPAT panel which is part of the REFERENCE subsystem. FPAT panel displays long edit text. In this example the text for edit 380 is displayed on the FPAT panel.

Table of MMIS SERVICE AGREEMENT - ASA1 panel 
 NEXT: ASA2                   MMIS SERVICE AGMT - ASA1  
                   AUTHORIZATION NBR: 0000 000 0 000                            
     AGMT STAT: T PRTL SUSP                       CURR LOC/DT: 000        MMDDYY
     AGMT TYPE: S DD DIV                    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: 0000000000   CASE MANAGER                                 
       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):                  
   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:   000.00         
  TOT USED UNITS:      00.000                    TOT USED AMT:   00000.00       
 LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID  LI EXC ST USER ID  +  
 01 380  C          03 380  C          02 380  C          04 380  C             
 380 AUTOMATIC LINE ADJUSTMENT


Table of MMIS PA/SA EXC RESLT-FPAT panel 
 NEXT: FPAT                   MMIS PA/SA EXC RESLT-FPAT 
                                                                                
 PA/SA EXC RESOLUTION CODE: 380  DESC: AUTOMATIC LINE ADJUSTMENT                
 ***** ***************************** TOP OF DATA ****************************** 
 00001 THIS EDIT WILL POST BECAUSE THE LINE WAS AUTOMATICALLY ADJUSTED.         
 00002 PRESSING F9 AND SAVING THE DOCUMENT WILL REMOVE THIS EDIT.  APPROVE      
 00003 THE NEW LINE ITEM AND HEADER IF NEEDED.                                  
 ***** **************************** BOTTOM OF DATA **************************** 
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
 ENTER--PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10--PF11--PF12  
  PAGE              S/EXT             N/EXT  PREV  NEXT        OOPS

Exception code fields on MMIS panels (refer to Table of ASA1 panel)

LI field indicates the line item that edit is posting on. For example, 01 = line one. A code of 00 in the LI field indicates that the edit is posting at the header level, meaning the edit applies to the entire document or claim.

EXC or ERR field displays the exception code. Edits are identified as three digit numbers. EXC field is on documents in the PRIOR AUTHORIZATION APPLICATIONS and ERR field is on claims in the CLAIMS PROCESSING APPLICATIONS.

ST field identifies the status of the edit.

  • Status of 6 is informational only.
  • Status of 3 will deny the document.
  • Status of 4 suspends the document.
  • Status C is for clear. This is used to fix status code when code turns red. In this example all the posted edits have a status of C.
  • Status F means the edit was forced in specific situations where edit is not resolved but exception is allowed.
  • Claims have a more extensive list of valid values that are not included in this course.

USER ID field displays the ID of the worker who forced an edit when the edit status is F.

How to navigate to view edit text in MMIS

  1. Navigation to view edit text is the same in all subsystems where MMIS posts edits. See example of Table of ASA1 panel.
  2. MMIS displays the short description of the first edit at the lower left corner of screen. If there is more than one edit posted only the first edit short description is displayed.
  3. To display short description of other edits place cursor on the edit number and press function key F1.
    • In the first table above the short edit text displayed is 380 AUTOMATIC LINE ADJUSTMENT.
  4. To display the long text for an edit place the cursor on the edit number and press function key F4.
    • In the second table above of the FPAT panel, the long edit text is displayed for edit 380.
    • The long text describes why the edit posted and possible corrective action to be taken.
    • When there is a + at the end of edit text this means there is additional text. Press F8 to view addition edit text. Press F7 to return to previous page of text.
    • To return to the service agreement press function key F6.
  5. To view additional edits when there is a + or +/- following the LI EXC ST USER ID fields place cursor in edit area and press F8 to advance and F7 to return.

On this page of the course we have learned how to navigate to view edit text in MMIS. In inquiry mode worker is able to view edit text. In Add and Change mode worker is able to view edit text and prompt MMIS to edit a document. On the next page we will learn about these prompts.

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