MH-WIN SUD Reference Manual - Detroit Wayne Mental Health
Contents
1. s episode the member must be discharged timely using the last date of treatment Click on the hyperlink SUD _Dischard_ Form to discharge a member Should a member relapse and chooses to go elsewhere within the Authority s region a member cannot be admitted elsewhere if he or she is not discharged Therefore it is EXTREMELY IMPORTANT to maintain a member s record in a timely fashion Remember a member s eligibility must be checked on a monthly basis so one knows which treatment services are available to a member Utilize either the blue navigation button labeled Medicaid 7 9 2015 10 45 AM Page 7 of 9 Autho os rity yne Mo ene a SUD Provider MH WIN Reference Manual Eligibility on the left of the main menu as illustrated in Figure 1 or use the blue hyperlink in the member s record on the top right as displayed in Figure 2 Status MH Open SUD Open Chart Documents I Diagnosis Health Information gt BD Eligibility Insurance Figure 2 One may utilize the Consumers navigation button in Figure 1 to obtain specific information about a member Please take a moment to familiarize yourself with what is available Using the Authorizations navigation button displayed in Figure 1 allows a user to look at specific authorizations for a member or to view all authorizations for your facility It also houses the ability to print a report of authorizations Check it out As you know the SUD CA2. transferred to MH WIN Staff To Do List Calendar 2 SUD Self Pay Co Pay Polic Add Change View SUD Self Pay Co Pay policies D cre y Co Pay policies EASGE Change Password REF 7 3 SUD Referral Forms SARF Admission Discharge Return to Original User D gt Click here to view and add SUD Referral Forms Admissions and Discharges SUD Referral General Search 2 Click here to search SUD Referrals based on client and provider myPage Change In Level Of Care Forms p gt Add Change and View Change In Level Of Care Forms myPage eee Monday June 15 2015 12 08 PM Eastern Time aay PCE Care Management Copyright 1999 2015 PCE Systems Inc All rights reserved Figure 1 7 9 2015 10 45 AM Page 2 of 9 Autho os rity SUD Provider MH WIN Reference Manual Just under the header of the system in a darker blue you have Home Logout Help and a pic of an Envelope Main Navigation Bar Home will take you back to your Main Menu regardless of where you are in the system Logout allows you to safely remove your access from the system and is recommended before closing your browser window THIS IS FOR YOUR PROTECTION Help provides you links to reference materials to assist you as well as information for contacting DWMHA s MH WIN Help Desk When contacting the MH WIN Help Desk via email utilize a Member ID when referencing a member and NEVER use any Patient Health Information
3. PHI when inquiring upon a member Using PHI in an email is a HIPAA violation and is in violation of your organization s contract with DWMHA Envelope is MH WIN s message system It is here that you can send and receive secure messages from and to other users in MH WIN where PHI can be used This messaging system should only be used for MH WIN related activity Only one attachment per email is allowed In addition this is where report results can be accessed they will be noted as an attachment paper clip is displayed To access a report click on the paperclip and choose to SAVE the report You will find it in your download folder of your Window s Explorer Note under the DWMHA logo the affiliate to which your login is assigned is displayed IF a News Flash is present it will appear in gray as it does above in Figure 1 An announcement must be acknowledged using the clear button to make it go away All users who receive a News Flash must read and are accountable for the content displayed On the left in light blue is the MH WIN Navigation pane Notice SUD CA is highlighted in yellow and its contents are displayed on the right with additional access Also note the Provider Agency is displayed above so you know where you are logged into should you have other user ids For those who may be familiar to Netsmart s CareNet system 3 SUD Referral Forms SARF Admission Discharge is where you can find all information pertaining to
4. a member You may search for a member in various ways using parts of a first and or last name or member id or SSN or Medicaid ID Note the more information provided the narrower the search becomes use with care Try multiple ways to search for a member before contacting Pioneer 800 241 4949 or the Help Desk to locate a record Additionally ensure a Release of Information has been faxed to 877 909 3950 before making an inquiry Once the member has been located click on the SUD Forms hyperlink to the right to access the various portions of a client s record Under the Menu Navigation Bar on the top the member header is displayed which includes basic demographic information as well as the current status of case for Mental Health MH and Substance Use 7 9 2015 10 45 AM Page 3 of 9 Autho eo rity SUD Provider MH WIN Reference Manual Disorder SUD If a current assignment exists it will be displayed under Current Assignments On the right of the header are additional links that are relative to a member such as chart documents diagnosis history health information and eligibility info Below the Member Header are links that will take you to the various records noted The Integrated BioPsychosocial BPS Records is where you will find the member s initial and subsequent assessments All records in the Member Header pertain to information applicable to the agency one is logged into Claims is where one will find a mem
5. tied to your account Don t have an NPI Apply for one with NPPES at https nppes cms hhs gov NPPES Welcome do It is quick and easy to register 9 Your screen may look something like this depending upon other access you may or may not have 7 9 2015 10 45 AM Page 1of9 DWMHA SUD Provider MH WIN Reference Manual 4 Mental Health ag a irra as Yda MATION Mental Health Wellness Information Network DWMHA SUD NETWORK Attention ALL PROVIDERS When billing treatment services box 32 must reflect the site in which the admission and services reside and NOT the billing Admin address 06 15 15 10 02AM Populating box 32 in the HCFA 1500 with the billing address rather than the actual address of site where the services were performed will render an error message stating there is no open admission Please check this before reporting this as an issue and thank you for your cooperation Consumer Chart Go to Consumer Chart consisting of all documents in EMR and a page of links MI Health Link D gt that makes it easier to move from one form to another within a consumer s chart SUD CA Reports and Downloads ______ 1 Integrated BioPsychosocial Assessment System Setup Add change or view Integrated BioPsychosocial assessments for a consumer All Claim Submission AP D gt completed Integrated BioPsychosocial assessments will be automatically
6. Autho os rity SUD Provider MH WIN Reference Manual 1 Obtain User ID and Password from your System File Maintenance SFM designee from your agency 2 Permissions should include both Billing and Clinical regardless of your role The combination of the two provide access to all necessary portions of a client s chart 3 The first time you are given access you will be required to change your password 4 You are NOT to share this access with any of your co workers including your supervisor as this is for your protection You may be asked for your user id from tech support to assist you with help however they will not ask for your password 5 Every 90 days you will be required to change your password Inactivity of your account within a 90 day period will automatically close your account 6 In addition three attempts of incorrectly logging in will automatically lock you out of the system You will be required to request a password reset Default password will equal your User ID and will require an immediate password change Obtain reset from your SFM The system is case sensitive 7 Access the Quick Reference Guide for more information https drive google com file d OB WY7Xu8UNILNUIxXSDNPLUt3LVU view usp sharing 8 If you are a clinician who will be rendering services to a member you must provide all licensing numbers in addition to your National Provider Identification NPI number to your SFM so they can be
7. ber s treatment history within the Provider once the services have been billed and generated into encounters Following the links for further access is a display of the SARF Admission and Discharge information This entire screen is designed to give the viewer a quick and dirty snapshot of a member s status The SARF Referral Date and Release Status lets you know if and when a SARF was created and its current status Following 3 31 a Pioneer Agent s Name will appear in the Form Completed By column if a SARF has been generated Depending upon one s access for various sites of a Provider a user can see the various sites within the Provider column revealing the associated admission discharge linked authorizations as well as links to the forms to perform various activities This is where a form can be viewed changed deleted or added Note if a linked authorization exists to a specific form that form cannot be deleted or cleared because dependency exists Note the Referral Date can be but is not necessarily the date in which the SARF was generated It is quite possible to have the creation date be different than the Referral Date if a different agent is releasing the SARF to the Provider on a date other than the creation date the most recent displays BEWARE this may impact the date of the SARF Admission MPORTANT When navigating within MH WIN ALWAYS use MH WIN back button to back out of a screen rather than your b
8. navigation button permits a user to access a member s chart assessment self pay policies referrals general search on referrals which allows visibility of referral status and access to change in LOC forms At this time the only available report for the Provider Network is the Clam Detail Report Download which is located from the main menu Reports and Downloads navigation button System Setup is for SFM use only Claims Submission AP is the billing navigation button in Figure 1 on the left hand side which allows claim entry submission of batches to PIHP Authority upload of 837s and viewing of claims by member Please use the Blank Prints navigation button as displayed in Figure 1 to access blank forms to download to assist your place of business operations A User s password can be changed at any time using the Change Password navigation button as shown in Figure 1 7 9 2015 10 45 AM Page 8 of 9 SUD Provider MH WIN Reference Manual Additional References SFM Guideline https drive google com file d OB WY7Xu8UNILU2JtdG1qVHZlaFU view usp sharin Adding NPI to Clinician https drive google com open id 0B WY7Xu8UNILdXIPR3Y1bEwyOG8 amp authuser 0 Room and Board Policy hitps drive google com file d OB WY7Xu8UNILcC2M4VGZZaW13NFk view usp sharing General FAQs https drive google com file d OB WY7Xu8UNILN1iRjQIdIVXdrMzA view usp sharin MH WIN User Manual https drive google com file d OB WY7X
9. ne applicability Please remember services are determined by medical necessity and contract allocation For members that are in treatment beyond 90 days a BPS is required every 90 days to show progression and justification for continuation of treatment In these cases please use the copy feature and make the appropriate changes Services utilizing internal modifiers beginning with a Z must be used for requesting an authorization as well as for billing Utilizing a code without an internal modifier when one is assigned will result in a billing error No rate found Now that the admission is in place the biller can bill for the intake performed Please reference the following material for billing e Quick Reference Guide for Billing https drive google com file d OB WY7XuU8UNILMORjSVh4bVoyQWs view usp sharing 7 9 2015 10 45 AM Page 6 of 9 DWMHA SUD Provider MH WIN Reference Manual e Provider Claim Submission User Manual https drive google com file d OB WY7Xu8UNILU1k3cUc1SjB5bEE view usp sharing e Change Batch Guide https drive google com file d OB WY7Xu8UNILNzgxWU9SOTIIdXM view usp sharing e Internal Modifiers https drive google com file d OB WY7Xu8UNILMHUyTE14YVdTUXc view usp sharing e Tie Specific Clinician to Various Claim Lines https drive google com open id 0B WY7Xu8UNILdXIPR3Y1bEwyOG8 amp authuser 0 e Billing FAQs https drive google com file d OB WY7Xu8UNILeVZ2Sm51b0VGTVU view usp
10. our agency is not contracted for PA2 then this funding should be answered as No Both questions must be answered The Self pay policy should be ended when a member is discharged and the date used should be the discharge date which MUST reflect the last date of treatment per the State If the member comes back to the agency a new self pay policy must be opened This allows for a financial history in the system Upon completion of the Self pay policy an initial assessment Integrated BioPsychosocial BPS form must be completed This justifies the level of care a member is placed This may confirm the referred level of care however if it does not and the Provider Agency is not contracted for the appropriate level of care necessary it is the Provider s responsibility to contact Pioneer in order to place the member appropriately Here is a link to the BPS Guidelines https drive google com open id 0B WY7Xu8UNILOGJOM3c5elRrWmc amp authuser 0 An admission form is then required Click on the hyperlink SUD Admission Form to add an admission all fields are required SAVE TIP 1 GAF Score though subjective should be populated 2 Co Dependent should always be answered as No because DWMHA is not currently supporting this type of program 3 The Number of Prior SUD Treatments refers to how many times the member has attempted to address his or her SUD issues 4 Source of Referral should reflect what caused the member to
11. rowser s back button When the Admission and Discharge columns are blank this indicates a form does not exist Even when dates do exist prior to 4 1 this only indicates a form is present and does not ensure it is complete During the conversion not all fields were populated in MH WIN because there are more fields in MH WIN than were present in the previous system To alleviate stress down the road make sure the forms are complete in their entirety Once a faxed Release of Information is received by Pioneer the record is released to a Provider it is the Provider s responsibility to ensure a SUD Self pay Policy exists and reflects the member s current situation Incomplete Self pay Policies prevent commencement of billing Eligibility should be checked prior to completion of the self pay policy Note this policy must be complete in its entirety Incomplete converted policies should be deleted and re entered to prevent billing issues down the road If your agency is not contracted for SDA then this question should never reflect Yes SDA State Disability Assistance is only used for Room and Board in a residential setting only and must be accompanied with an approved application in a clients chart reference memo for more information 7 9 2015 10 45 AM Page 40f9 Autho oo rity yno Men SUD Provider MH WIN Reference Manual https drive google com file d OB WY7Xu8UNILSWhqU2dBSIU2Z2s view usp sharing Likewise if y
12. scovered the admission MUST be edited and changed to reflect such NOTE The ONLY time a field is to be changed on an admit is when an error is corrected however THIS is an exception to the rule because it governs how the modifiers are being used on the backend Remember the admission is a snapshot in time 11 Though the order of WSS Women Specialty Services is out of sorts how the questions are answered is important If a member has dependent children the quantity is noted If he or she is trying to regain custody or if there is child welfare involvement and the member is responsible for the child children this makes the member eligible for WSS and should be marked as Yes If the Provider is deemed by the Authority to be gender competent and the member is admitted into such a program then Women s Specialty Program Admitted should be marked as Yes In either case the HD modifiers are governed by these answers in conjunction with the Provider contract for funding from the WSS BG pot When Pioneer screens and places a member with a Provider by choice treatment services that are authorized are determined by the initial eligibility check at the time of screening Therefore not every member is released with drug screens room and board etc It is at the time of requesting authorization that these other services are requested and authorized as justified by the request information and assessment that UM uses to determi
13. seek treatment This should never reflect Central Assessment CDR 5 IF Not in the Competitive Labor Force is selected in Employment Status then the reason must be noted in the Detailed Not in Labor Force section 6 The ONLY time the Number of Dependents should equal 0 is when the member is an adolescent and is claimed as a dependent on a guardian s income taxes otherwise this field should at minimum reflect 1 for the client and include any others that the member is responsible for as a dependent up to 12 7 The number of Times Arrested in the Last 30 Days should be reflected in the last FIVE years 8 The only time Methadone Part of Treatment at This Agency can be marked as Yes is if the Agency is licensed to dispense Methadone and it is part of the member s actual treatment 7 9 2015 10 45 AM Page 50f9 Autho os rity yne Mo ene a SUD Provider MH WIN Reference Manual 9 Other Factors select as applicable in order of severity beginning with Factor 1 10 Indication of Mental Health Issues on this form in MH WIN has two purposes Initially it must reflect actual condition of the member When marked as Yes all services when submitted to the State as an Encounter will be submitted with the HH modifier Therefore IF initially documented as No and then through the course of treatment it is determined this should be Yes at the time mental health issues are di
14. sharing The clinician can create the treatment plan and request appropriate services as necessary Please refer to Clinical FAQs for reference https drive google com file d OB WY7Xu8UNILUINNbXFIQOh4bjA view usp sharing In order for a Provider Agency to receive referrals the calendar must be populated with slot availability so Pioneer can release a SARF Please refer to https drive google com file d OB WY7Xu8UNILdWh6SV9jRXdnRUk view usp sharing to access the Quick Reference Guide for use of the Calendar in MH WIN and Provider Calendar Guide https drive google com file d 0B WY7Xu8UNILVWFSdW1aQ1gtNGs view usp sharing Through the course of a member s treatment he or she may step up or step down in levels of care as appropriate When a Provider Agency is contracted for various Levels of Care LOC a Change in Level of Care form can be used rather than having to discharge and re admit a member to the new LOC This is only appropriate if the levels of care are contracted within the same agency license Please reference the Change in Level of Care for guidance https drive google com open id 0B WY7Xu8UNILbGinakdpNTJQeXc amp authuser 0 IF a member is to be transferred to a different facility having a different license number the member MUST be discharged as of the last date of treatment and Pioneer is to be contacted to facilitate the transfer The discharge reason should be 06 Continuing in Treatment Upon completion of a member
15. u8UNILNXcxVmkybzVnVFE view 2usp sharing To Access This Manual https drive google com file d OB WY7Xu8UNILaVAweEx2QnFiUlE view usp sharing News Flashes https drive google com file d OB WY7XU8UNILRzRlazZ4YW51Z3c view 2usp sharin 7 9 2015 10 45 AM Page 9 of 9
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