LTC Online Portal Messages. Sequencing Rules Provider Workflow

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1 LTC Online Portal Messages Sequencing Rules Provider Workflow NURSING FACILITY April 2009

2 Table of Contents OVERVIEW...3 SUBMISSION VALIDATION RULES AND EDITS...4 FORM 3618 RESIDENT TRANSACTION NOTICE EDITS...5 FORM 3619 MEDICARE/SNF PATIENT TRANSACTION NOTICE EDITS...10 RESOLVING VALIDATION ERRORS...12 PROVIDER WORKFLOW...13 FINDING ASSESSMENTS/FORMS WITH PROVIDER ACTION REQUIRED STATUS...14 PROVIDER WORKFLOW REJECTION MESSAGES...21 FREQUENTLY ASKED QUESTIONS AND 3619 SUBMISSION VALIDATION RELATED QUESTIONS:...29 PROVIDER WORKFLOW RELATED QUESTIONS:...29 OTHER QUESTIONS:...30 FAQ WEBSITE...30 ADDITIONAL ASSISTANCE...30 NF Provider Enhancements Page 2 Last Updated: April 1, 2009

3 Overview The TMHP (Texas Medicaid and Healthcare Partnership) Long Term Care (LTC) Online Portal includes: 3618 and 3619 submission validations and a, Provider Workflow Submission validations are 3618 and 3619 form sequencing rules that provide notification to providers when forms are being submitted out of sequence. This validation will not prevent providers from submitting retroactive dates of above transaction. It is intended to control the submission of a subsequent date of above transaction compared to the most current date of above transaction. This validation will occur at the time of submission when the Submit Form button is clicked. Providers benefit from this real-time validation as the provider can resolve the validation edit error immediately. Submission validations in summary: occur at the time of submission errors are displayed real-time (immediately) at the top of the portal page form is not submitted until error(s) are resolved form status is blank and DLN is not assigned until error(s) are resolved Provider Workflow allows providers to independently manage their assessments/forms when errors in the nightly batch processing occur. This functionality allows providers to directly manage their rejections which occurred during the nightly batch execution. The benefit is shorter time in resolution of these types of errors because the provider is responsible for resolving these errors. Provider Workflow in summary: assessment/form has not been successfully processed error occurred during the nightly batch processing rejection error message can be found within the assessment/form history ownership for resolution belongs to the provider assessment/form status is Provider Action Required NF Provider Enhancements Page 3 Last Updated: April 1, 2009

4 Submission Validation Rules and Edits Any one of the situations in the table below will result in a sequencing validation error at the time of form submission. The form will not be accepted until all errors are resolved. The system messages will display at the top of the portal submission page. If you do not receive the DLN number assigned page after clicking Submit Form, there are errors that need to be resolved. The errors will be displayed at the top of the page therefore you will need to scroll to the top of the page to see the errors. Validation edits are based on three levels: Form Type, Transaction and Date of Above Transaction Form type admission 3618 must be discharged with a 3618 before submitting a 3619 and the reverse Transactions must alternate between admission and discharge Date of above transaction should be chronological unless submitting a form effective retroactive. Retroactive forms should be submitted in pairs creating or filling a gap of time. Forms with the following statuses are excluded from consideration in meeting form sequencing requirements: Corrected, PCS Invalid/Complete, Invalid Form Sequence 3619, ID invalid, Inactivated, Med ID Check Inactive, ME Check Inactive, AI Check Inactive. The errors will display real-time at the time of a 3618 or 3619 form submission. There are different errors dependent upon the form type, therefore, the error messages below have been categorized by form type. The table below contains 3 columns: 1. System Message. This is the specific error message that will be displayed in the portal at time of submission. 2. System Message Clarification. Further clarification of the portal error message including basic example of the situation. 3. System Message Resolution. Assistance with resolving the error. For those situations where a form is missing, providers will need to submit the missing form in order for the erroring form to pass validations. The provider has two options regarding the submissions. 1. If a submission displays a message that a form is missing, the provider can save the form as draft. Submit the missing form and then retrieve the draft and submit to complete both transactions. 2. If the submission displays that a form is missing, that form can be adjusted to submit the missing form and then using use as template the original form can be submitted now that the edit has been resolved. The submission of the missing form and the erroring form can occur the same day. The missing form will need to be submitted and then the erroring form. Providers do not need to wait for the missing form to process overnight. NF Provider Enhancements Page 4 Last Updated: April 1, 2009

5 Form 3618 Resident Transaction Notice Edits System Message (displayed at time of submission) Last form submitted was an admission. Please supply discharge form prior to this admission. Edit Description System Message Clarification Rejection of New Admission for missing Previous Discharge New admission follows an admission for same contract i.e admission (no discharge) admission submitted System Message Resolution (assistance for resolving error) Submit a discharge prior to this admission. Attempting to submit two 3618 admissions in a row, missing a 3618 discharge. Submit the missing discharge then submit the 3618 admission. NF Provider Enhancements Page 5 Last Updated: April 1, 2009 Scenarios: 3618 admit exists in Processed/Complete status for client A, provider A, transaction date = 10/20/ admit submitted for client A, provider A, transaction date = 10/21/08. Submission is not allowed without a prior discharge admit exists in Corrected status for client A, provider A, transaction date = 10/20/ admit submitted for client A, provider A, transaction date = 10/21/08. Submit allowed. (Previous admit in corrected status so not considered) 3618 admit exists in ME Check Inactive status for client A, provider A, transaction date = 10/20/ admit submitted for client A, provider A, transaction date = 10/21/08. Submit allowed. (Previous admit in ME Check Inactive status so not considered)

6 System Message (displayed at time of submission) (CONTINUED) Last form submitted was an admission. Please supply discharge form prior to this admission. Edit Description System Message Clarification System Message Resolution (assistance for resolving error) 3618 discharge exists in Processed/Complete status for client A, provider A, transaction date = 10/19/ admit exists in Processed/Complete status for client A, provider A, transaction date = 10/19/ admit submitted for client A, provider A, transaction date = 10/21/08. Submission is allowed because of multiple matching date of above transaction on prior form. Last form submitted was a discharge. Please supply admission form prior to this new discharge. Rejection of New Discharge for missing Previous Admission New discharge follows a discharge for same contract i.e discharge (no admission) discharge submitted Submit an admission prior to this discharge. Attempting to submit two 3618 discharges in a row, missing a 3618 admission. Submit the missing admission then submit the 3618 discharge. NF Provider Enhancements Page 6 Last Updated: April 1, 2009

7 Same contract: An admission has already been received for the Date of Above Transaction. OR Different contract: An admission from another provider has already been received for the Date of Above Transaction Rejection of New Admission for Same Date of Above Transaction. New admission has same Date of Above Transaction as an admission already received i.e admission admission Same contract: Possibly attempting to submit a duplicate form. OR Different contract: A different provider has previously submitted an admission for the same Date of Above Transaction date. One provider is in error. Contact other provider. Scenarios: 3618 admit exists in Processed/Complete status for client A, provider A, transaction date = 10/1/ admit exists in Processed/Complete status for client A, provider A, transaction date = 10/21/ admit submitted for client A, provider A, transaction date = 10/1/08. Submit not allowed because date already in Processed/Complete. System Message (displayed at time of submission) (CONTINUED) Same contract: An admission has already been received for the Date of Above Transaction. OR Different contract: An admission from another provider has already been received for the Date of Above Transaction Edit Description System Message Clarification System Message Resolution (assistance for resolving error) 3618 admit exists in Processed/Complete status for client A, provider A, transaction date = 10/1/ admit exists in Processed/Complete status for client A, provider A, transaction date = 10/21/ admit submitted for client A, provider B, transaction date = 10/1/08. Submit not allowed because date already in Processed/Complete for another provider. NF Provider Enhancements Page 7 Last Updated: April 1, 2009

8 Same contract: A discharge has already been received for the Date of Above Transaction OR Different contract: A discharge from another provider has already been received for the Date of Above Transaction Rejection of New Discharge for Same Date of Above Transaction New discharge has same Date of Above Transaction as a discharge already received i.e discharge discharge Same contract: Possibly attempting to submit a duplicate form. OR Different contract: A different provider has previously submitted a discharge for the same Date of Above Transaction date. One provider is in error. Contact other provider. Previous form was a A 3619 discharge or 3618 admission (as appropriate) must be submitted before a 3618 discharge can be submitted. Applicable for same or different contract. Rejection of 3618 Discharge following a discharge received following a 3619 regardless of contract. Submit either a 3619 discharge or 3618 admission (as appropriate) prior to this 3618 Discharge. Scenarios: 3619 admit exists in Processed/Complete status for client A, provider A, transaction date = 10/20/ admit submitted for client A, provider A, transaction date = 10/21/08. Submit not allowed discharge exists in Processed/Complete status for client A, provider A, transaction date = 10/20/ discharge submitted for client A, provider A, transaction date = 10/21/08. Submit not allowed. NF Provider Enhancements Page 8 Last Updated: April 1, 2009

9 System Message (displayed at time of submission) (CONTINUED) Previous form was a A 3619 discharge or 3618 admission (as appropriate) must be submitted before a 3618 discharge can be submitted. Applicable for same of different contract. Edit Description System Message Clarification System Message Resolution (assistance for resolving error) 3619 admit exists in Processed/Complete status for client A, provider A, transaction date = 10/19/ discharge exists in Processed/Complete status for client A, provider A, transaction date = 10/19/ discharge submitted for client A, provider A, transaction date = 10/21/08. Submit not allowed. NF Provider Enhancements Page 9 Last Updated: April 1, 2009

10 Form 3619 Medicare/SNF Patient Transaction Notice Edits System Message (displayed at time of submission) Last form submitted was an admission. Please supply discharge form prior to this new admission. Last form submitted was a discharge Please supply admission form prior to this new discharge. Same contract: An admission has already been received for the Date of Above Transaction OR Different contract: An admission from another provider has already been received for the Date of Above Transaction Edit Description System Message Clarification Rejection of New Admission for missing Previous Discharge New admission follows an admission for same contract i.e admission (no discharge) admission submitted Rejection of New Discharge for missing Previous Admission New discharge follows a discharge for same contract i.e discharge (no admission) discharge submitted Rejection of New Admission for Same Date of Above Transaction New admission has same Date of Above Transaction as an admission already received i.e admission admission System Message Resolution (assistance for resolving error) Submit a discharge form prior to this admission. Attempting to submit two 3619 admissions in a row, missing a 3619 discharge. Submit the missing discharge then submit the 3619 admission. Submit an admission form prior to this discharge. Attempting to submit two 3619 discharges in a row, missing a 3619 admission. Submit the missing admission then submit the 3619 discharge. Same contract: Possibly attempting to submit a duplicate form. OR Different contract: A different provider has previously submitted an admission for the same Date of Above Transaction date. One provider is in error. Contact other provider. NF Provider Enhancements Page 10 Last Updated: April 1, 2009

11 Same contract: A discharge has already been received for the Date of Above Transaction OR Different contract: A discharge from another provider has already been received for the Date of Above Transaction Previous form was a A 3618 discharge or 3619 admission (as appropriate) must be submitted before a 3619 discharge can be submitted Rejection of New Discharge for Same Date of Above Transaction New discharge has same Date of Above Transaction as a discharge already received i.e discharge discharge Rejection of 3619 Discharge following a discharge received following a 3618 (regardless of contract on form) Same contract: Possibly attempting to submit a duplicate form. OR Different contract: A different provider has previously submitted a discharge for the same Date of Above Transaction date. One provider is in error. Contact other provider. Submit either a 3618 discharge or 3619 admission (as appropriate) prior to this 3619 Discharge. NF Provider Enhancements Page 11 Last Updated: April 1, 2009

12 Resolving Validation Errors Form sequencing validations will occur real-time when the provider submits a form. If a validation error occurs, the error(s) will display in the top half of the portal screen. A form is not considered submitted until the form passes all validations and a DLN is assigned. A form that does not have an assigned DLN has not been accepted into the LTC Online Portal. To resolve the error(s): 1) Save the form as a draft using the Save as Draft button on the form receiving the error(s). This saves the data that has been entered. A form that has not been accepted into the Portal and does not have an assigned DLN can be saved as a draft form. 2) Perform the necessary actions to resolve the error(s). a sequencing edits can be found by clicking here. b sequencing edits can be found by clicking here. 3) Retrieve the original form receiving the error(s). a. Click on My Drafts in the blue bar, locate the form in the list provided and click Open. NF Provider Enhancements Page 12 Last Updated: April 1, 2009

13 4) Submit the form by clicking the Submit Form button found on the bottom right of the screen. If there are still outstanding errors, repeat the resolution process above until the form is successfully submitted. A form is not considered submitted until the form passes all validations and a DLN is assigned. The following message will appear with a DLN when the form has been successfully submitted: Provider Workflow The provider workflow is the responsibility of the provider to monitor and manage. Forms and assessments end up in the provider workflow as a result of the nightly batch processing discovering an error while attempting to process the assessment/form. Nightly batch processing errors are found within the history of the assessment/form and the status is set to Provider Action Required. Once an assessment/form status is Provider Action Required, the assessment/form will require provider action before processing on that particular assessment/form continues. Type of Forms being sent to the Provider Workflow include: 3618, 3619, MDS and MDSQTR. If a nightly batch error occurs, the error will display in the history of the assessment/form. The assessment/form status will be Provider Action Required. NF Provider Enhancements Page 13 Last Updated: April 1, 2009

14 Finding Assessments/Forms with Provider Action Required status To find the items in your provider workflow (i.e. those items with nightly batch processing errors to be resolved by the provider): 1) Click on Form Status Inquiry in the blue bar. 2) Choose Type of Form from the drop-down list. NOTE: 3618, 3619, MDS and MDSQTR Type of Form in the drop-down list could result in a status of Provider Action Required therefore each of these Type of Form must be reviewed individually. This example will continue with choosing the Providers will need to review all the other applicable Type of Forms as well. NF Provider Enhancements Page 14 Last Updated: April 1, 2009

15 3) Enter the From Date and To Date range and choose Provider Action Required from the Form Status drop-down list. 4) Submit the Inquiry by clicking the Search button found on the bottom right of the screen. 5) Those 3618 forms with a status of Provider Action Required will display. NF Provider Enhancements Page 15 Last Updated: April 1, 2009

16 NOTE: for confidentiality purposes, the form details (i.e. Medicaid #, etc) have been hidden in this document. 6) Click the View Detail hyperlink to open the form. 7) Scroll to the bottom of the page to view History. 8) Find Provider Action Required status on the far left. It should be the last line in history. NF Provider Enhancements Page 16 Last Updated: April 1, 2009

17 9) Find the rejection message in the white line just below the Provider Action Required. 10) Perform the necessary research to resolve the error. a. Provider Workflow rejection messages can be found here. 11) Depending on the provider research, providers have one of three options to move the assessment/form out of the provider workflow. Correct this form. Correct this form allows provider to submit a correction. The original form with a status of Provider Action Required will be given a status of Corrected and will have a parent DLN to the new/child form. The new form replaces the original form. Inactivate Form. Inactivate Form will inactivate the form and given a status of Form Inactivated. Forms with a status of Form Inactivated cannot be corrected or re-submitted. An example of when this action would be used is when the provider research indicates the form being submitted is a duplicate. Resubmit Form. Resubmit Form will change the form status to SAS Request Pending. The assessment/form will process during the nightly batch processing. Check the status of the assessment/form the next day to determine if the assessment/form processed successfully. Status will be Processed/Complete if successfully processed. 12) If the provider chooses Correct this form, the provider will complete a new form/assessment. The original form/assessment that was in the status of Provider Action Required will be placed in a status of Corrected with a parent relationship DLN to the new/child assessment. The new assessment replaces the original assessment. If the provider chooses Inactivate Form, the provider will receive the following confirmation window. NF Provider Enhancements Page 17 Last Updated: April 1, 2009

18 Click OK to Inactivate and the assessment status will change to Inactivated. Click Cancel to cancel the Inactivation request keeping the assessment status as Provider Action Required. If the provider has chosen Resubmit Form, the following screen will appear allowing the provider to add any comments. There is an option to select 2-System or 1-ProviderFacing 2-System: will allow comments entered by the provider to be seen only by internal state staff. The comments will not be able to be seen by the provider. 1-ProviderFacing: will allow comments entered to be seen by both state staff and the provider. In either case, the comments will be seen in the History section of the assessment. The provider may choose to enter comments. Entering comments is optional. Click Cancel button to cancel the request keeping the assessment in the status of Provider Action Required OR Click Change Status button to move the assessment out of the Provider Action Required. 13) Once one of the actions has been completed: Correct this form, Inactivate form or Resubmit Form, the status of the assessment/form will no longer be Provider Action Required. Form processing will continue based upon action chosen. NF Provider Enhancements Page 18 Last Updated: April 1, 2009

19 14) Provider should repeat all the steps for a particular Type of Form until there are no more results found. Our example was using IMPORTANT: Don t forget, there are 4 Type of Forms that can end up in the Provider Workflow: 3618, 3619, MDS and MDSQTR. Once on type is completed with No Results Found, continue with the next Type of Form repeating all the steps to clear those with a status of Provider Action Required. An alternate method for working forms in Provider Action Required is to use Current Activity. Current Activity will show any assessment/form that has changed status in the last 14 days. Once the assessment/form has been rejected over two weeks, it must be located using Form Status Inquiry. Once a form is being considered for Provider Action Required, providers may want to perform a client search to see if the client has any other assessment/forms rejected. Current Activity is in the blue navigation bar next to Form Status Inquiry NF Provider Enhancements Page 19 Last Updated: April 1, 2009

20 NF Provider Enhancements Page 20 Last Updated: April 1, 2009

21 Provider Workflow Rejection Messages Below are the rejection messages providers will receive as a result of an error occurring during the nightly batch processing. The messages are in order of message number. Note: Providers should note that the following error messages include detailed instructions to assist providers in better understanding how to handle forms in the Provider Workflow. These were identified as the top eleven messages nursing facilities get in their Provider Workflow. DADS and TMHP continue to identify additional messages that need detailed instructions. Error messages: GN-9103, NF-001, NF0002, NF0007, NF-0012, NF-0013, NF0017, NF-0019, NF-0023, NF-0028, and NF The table contains 3 columns: 1. System Message. This is the system message that will be displayed in assessment/form history. 2. Associated with Forms. What assessment/form can receive this message? a. AA8a = 01. Admission Assessment b. AA8a = 02. Annual Assessment c. AA8a = 05. Quarterly Assessment d. AA8a = 10. Significant Correction of Prior Quarterly Assessment 3. Suggested Action Button. The messages and suggested action button is written assuming that the rejected form is correct in Form Type, Date of Above Transaction and Effective Date. First verify that the rejected form is a valid submission. If the Form Type or Date of Above Transaction is incorrect, submit an inactivation of that form and submit the correct type or transaction. If the Date of Above Transaction is incorrect, submit a correction for the correct date and resolve any missing form issues. System Message (displayed in History) NF-0001: The request cannot be processed because the client's Applied Income is not available to SAS. Contact the client's Eligibility Worker to update the client's Applied Income. Once the Applied Income has been updated, this request can be resubmitted to SAS. Reject Message Description Associated with Forms Suggested Action Pull a MESAV for the client covering the date requested on the form. Note: If the client does not already have Service Authorizations for your contract, this information will not be available on the MESAV. If the MESAV does not show an Applied Income for the dates of the form, contact the client's HHSC Eligibility Worker to update the Applied Income records. - Once the Applied Income has been updated, resubmit the rejected form. If the client is already established in your facility, you may monitor the MESAV for updated Applied Income. If the MESAV does show an Applied Income for the dates of the form, resubmit the MDS rejected form. NF Provider Enhancements Page 21 Last Updated: April 1, 2009

22 System Message (displayed in History) NF-0002: The request cannot be processed because there is no gap in the Level records for this client, for the requested PC E timeframe. NF-0003: The request cannot be processed because the client does not have retroactive Medicaid eligibility. Please contact the local Eligibility Worker. NF-0007: The request cannot be processed because the client has an assessment on file that has a later effective date. Please allow 10 days for Provider Claims Services to manually process this request. Reject Message Description Associated with Forms MDS (AA8a=01, 02, 05) MDS (AA8a=01, 02, 05) MDS (AA8a=05) Suggested Action Pull a MESAV for the PC E dates requested on this form and verify the dates shown in the Level section of the client s MESAV. If the Level coverage dates on file are valid, a PC E is not needed. Inactivate the assessment on the Federal CMS database. If the expected gap is not reflected on the Level record, contact Provider Claims Services ( option 1) for assistance. If the PC E dates are wrong, correct the PC E dates on the LTCMI and submit. Once retro active eligibility is available, resubmit form Validate that the R2b Date on the MDS is correct. If an entry error has occurred, submit a modification to the Federal CMS database. If the R2b Date is correct, determine if the MDS was delayed in processing, or submitted out of order. Pull a MESAV to determine what the latest Level begin date is for the client. - If this R2b Date is prior to the Level begin date and both assessments are wanted for Medicaid payment, contact Provider Claims Services to request manual processing. - If this assessment is NOT wanted for Medicaid payment and is not dually coded for Medicare, inactivate the assessment on the Federal CMS database. - If the later assessment is NOT wanted for Medicaid payment and is not dually coded for Medicare, inactivate the assessment on the Federal CMS database and resubmit the current assessment on the Portal. Note: Dually coded forms can be inactivated, but consideration must be given to the result of inactivation on both Medicare and Medicaid payment. NF Provider Enhancements Page 22 Last Updated: April 1, 2009

23 Reject Message Description System Message (displayed in History) Associated with Forms Suggested Action NF-0008: The request cannot be processed because an assessment with the same effective date has already been processed. Please continue to Submit the earlier admission and click submit assessments based on the client's MDS assessment schedule. MDS (AA8a=05) resubmit form - retroactive forms must be submitted in pairs. NF-0009: The request cannot be processed because a later assessment has already been processed. Please continue to submit assessments based on the client's MDS assessment Validate dates, and either correct or click schedule. MDS (AA8a=10) invalid form if assessment is not needed. NF-0010: The request cannot be processed because an assessment with the same effective date has already been processed and is not a Quarterly. Please continue to submit assessments based on the client's MDS assessment Validate dates, and either correct or click schedule. MDS (AA8a=10) invalid form if assessment is not needed. NF-0011: The request cannot be processed because you have reached the limit of Swing Bed days for this client for a 12 month period. Please submit an admission if the client becomes eligible to receive additional Swing Bed services Verify dates, if incorrect submit correction. NF-0012: The request cannot be processed because SAS records indicate the client is currently in Hospice. If the client is no longer enrolled in the Hospice program, please contact the Hospice provider and request that they discharge the client from the program. Once the Hospice discharge is processed, resubmit your request. If the client is a Hospice recipient, inactivate your request. 3618, 3619 Review the facility's records to determine if the client is Hospice. If the client is Hospice, Inactivate the Nursing Facility form. Note: Form 3618/3619s should not be submitted on Hospice clients. If the client has requested to terminate the Hospice program, contact the Hospice provider and request that the provider submit a discharge Form If the Form 3071 has already been submitted, allow 10 days for processing before resubmitting the admission to SAS. Note: If the form rejects again, the Hospice provider needs to follow up with Provider Claims Services. - If the Form 3071 has not yet been submitted, allow the time requested by the Hospice provider for processing of the Hospice discharge before resubmitting the admission to SAS. NF Provider Enhancements Page 23 Last Updated: April 1, 2009

24 System Message (displayed in History) NF-0013: The admission cannot be processed because the client is already admitted into a facility. If a discharge prior to this admission is rejected, the rejected discharge must be processed first. This admission can then be resubmitted to SAS. If this is the initial admission into your facility, please contact the prior provider and request that they submit the missing discharge NF-0014: The request cannot be processed because an earlier admission has already been processed. If a discharge prior to this admission is missing, please resubmit once the matching discharge is submitted NF-0015: The request cannot be processed because an earlier admission from another provider has already been processed. Please contact the prior provider to have a discharge submitted. Please resubmit once the missing discharge is submitted NF-0016: The request cannot be processed because an earlier admission has already been processed. If a discharge prior to this admission is missing, please resubmit once the missing discharge is submitted. If this is the initial admission to your facility, please contact the prior provider to have a discharge submitted Reject Message Description Associated with Forms Suggested Action If this is the initial admission into your facility, please contact the previous provider and request that they submit a discharge on the client. If not, pull a MESAV for the client to determine the begin date of the current Service Authorization. - Based on the Service Authorization begin date and the effective date of the rejected admission, submit the discharge that falls between these dates. - Once the previous discharge has a status of SAS Request Pending, resubmit the rejected admission. Click resubmit form once the discharge has been submitted. Click resubmit form once the discharge has been submitted. Click resubmit form once the discharge has been submitted. NF Provider Enhancements Page 24 Last Updated: April 1, 2009

25 System Message (displayed in History) Reject Message Description Associated with Forms NF-0017: This admission cannot be processed because a later admission is already on file. This admission occurs in the past and must be one of a pair, which will create a separate Service Authorization. If the discharge following this admission is missing or rejected, both forms must be submitted to SAS on the same day. 3618, 3619 NF-0019: This discharge cannot be processed because the client is not admitted into this facility. If an admission prior to this discharge is rejected, the rejected admission must be processed first. This discharge can then be resubmitted to SAS NF-0020: The request cannot be processed because a later discharge has already been processed. If an admission after this discharge is missing, please resubmit with the submission of the matching admission NF-0021: The request cannot be processed because a later admission to another provider has already been processed. If an admission prior to this discharge is missing, please resubmit with the submission of the matching admission. 3618, 3619 Suggested Action Review the facility's records to determine which discharge follows this admission. Pull a MESAV and review the Service Authorizations to see if a gap exists for the period that will be created by the admission and discharge pair. - If a gap exists, resubmit the admission to SAS, then submit or resubmit the following discharge. Both forms must be submitted on the same day. The system will process both forms as a pair. - If a gap does not exist, review the facility's records to determine if a discharge prior to the rejected admission is reflected on the client s MESAV. If the discharge is not reflected on the client s MESAV, submit the missing or rejected discharge, followed by the admission and discharge pair. If the discharge is reflected on the client s MESAV, contact Provider Claims Services for assistance. Review the facility records to identify the admission prior to this discharge. - If the prior admission form was rejected, correct the form and submit. The admission must be processed before the discharge can process. - If the prior admission form is missing, submit the missing form on the Portal. Click resubmit form once the admission has been submitted. Click resubmit form once the admission has been submitted. NF Provider Enhancements Page 25 Last Updated: April 1, 2009

26 System Message (displayed in History) NF-0023: The admission cannot be processed because the client is already admitted into a facility. If a discharge prior to this admission is rejected, the rejected discharge must be processed first. This admission can then be resubmitted to SAS. If this is the initial admission into your facility, please contact the prior provider and request that they submit the missing discharge NF-0024: The request cannot be processed because an earlier admission has already been processed. If a discharge prior to this admission is missing, please resubmit once the matching discharge is submitted NF-0025: The request cannot be processed because an earlier admission from another provider has already been processed. Please contact the prior provider to have a discharge submitted. Please resubmit once the missing discharge is submitted NF-0026: The request cannot be processed because an earlier admission has already been processed. If a discharge prior to this admission is missing, please resubmit once the missing discharge is submitted. If this is the initial admission into your facility, please contact the prior provider about submitting a discharge Reject Message Description Associated with Forms Suggested Action If this is the initial admission into your facility, please contact the previous provider and request that they submit a discharge on the client. If this is not the initial admission into your facility, pull a MESAV for the client to determine the begin date of the current Service Authorization. Based on the Service Authorization begin date and the effective date of the rejected admission, submit the discharge that falls between these dates. Once the previous discharge has a status of SAS Request Pending, resubmit the rejected admission. Submit the earlier discharge and click resubmit form - retroactive forms must be submitted in pairs. Click resubmit form once the discharge has been submitted. Click resubmit form and submit the earlier admission - retroactive forms must be submitted in pairs. NF Provider Enhancements Page 26 Last Updated: April 1, 2009

27 System Message (displayed in History) NF-0028: The request cannot be processed because the Qualifying Stay days, plus any Full Medicare days already documented, add up to more than the 20 days allowed for this Spell of Illness NF-0029: The days of Qualifying Stay have been recorded. However, the request for Medicare Part A Co- Insurance cannot be processed because the Qualifying Stay days, plus any Full Medicare days already documented, are less than the 20 days required for this Spell of Illness NF-0030: The request cannot be processed because it has not been more than 60 consecutive days since the client was discharged from Medicare (cannot begin a new spell of illness). Please review Medicare remittance to determine when Medicare Co-Insurance is due. Submit a new Form 3619 based the client's Medicare remittance Reject Message Description Associated with Forms Suggested Action For each Medicare Spell of Illness, 20 days of Full Medicare coverage is required, between one or more providers. Check the Dates of Qualifying Stay From and To Dates on the form. The number of days on the form, plus any Full Medicare days already documented for that Spell of Illness, cannot exceed 20 days. If the Dates of Qualifying Stay on the form are wrong, correct the form and submit. If the Dates of Qualifying Stay on the form are correct, contact Provider Claims Services to request manual processing. Note: If this is not traditional Medicare, please document this in the comment section and call option 3 or Fax the Medicare Replacement's EOB with a copy of the 3619 to For each Medicare Spell of Illness, 20 days of Full Medicare coverage is required, between one or more providers. Check the Dates of Qualifying Stay From and To Dates on the form. The dates entered must add up to the 20 day requirement, or an additional form must document the remainder of the 20 days of Qualifying Stay. If the Dates of Qualifying Stay on the form are wrong, correct the form and submit. If the Dates of Qualifying Stay on the form are correct, submit another form to document the remaining days of Qualifying Stay, once that information becomes available. Note: If this is not traditional Medicare, please document this in the comment section and call option 3 or Fax the Medicare Replacement's EOB with a copy of the 3619 to Inactive form. Submit new form when Medicare Co-Insurance is due. NF Provider Enhancements Page 27 Last Updated: April 1, 2009

28 Associated with System Message Forms (displayed in History) NF-0033: The request cannot be processed because a later discharge has already been processed. If an admission after this discharge is missing, please resubmit with the submission of the matching admission GN-9101: The request cannot be processed because of the client's Financial Eligibility or Income. Please contact the local Eligibility Worker. GN-9102: The request cannot be processed because of the client's Financial Eligibility or Income. Please contact the local Eligibility Worker. GN-9103: The request cannot be processed because the client's Applied Income is not available to SAS. Contact the client's Eligibility Worker to update the client's Applied Income. Once the Applied Income has been updated, this request can be resubmitted to SAS. GN-9104: The request cannot be processed because of the client's Financial Eligibility or Income. Please contact the local Eligibility Worker. GN-9105: The request cannot be processed because of the client's Financial Eligibility or Income. Please contact the local Eligibility Worker. GN-9106: The request cannot be processed because of the client's Financial Eligibility or Income. Please contact the local Eligibility Worker. Reject Message Description 3618, 3619, MDS 3618, 3619, MDS 3618, 3619, MDS 3618, 3619, MDS 3618, 3619, MDS 3618, 3619, MDS Suggested Action Inactive form or click resubmit form once the admission has been submitted. Click resubmit form after MESAV reflects the appropriate coverage by the eligibility worker. Click resubmit form after MESAV reflects the appropriate coverage by the eligibility worker. Pull a MESAV for the client covering the date requested on the form. Note: If the client does not already have Service Authorizations for your contract, this information will not be available on the MESAV. If the MESAV does not show an Applied Income for the dates of the form, contact the client's HHSC Eligibility Worker to update the Applied Income records. - Once the Applied Income has been updated, resubmit the rejected form. If the client is already established in your facility, you may monitor the MESAV for updated Applied Income. If the MESAV does show an Applied Income for the dates of the form, resubmit the rejected form sitting in the Provider Action Required Workflow. Click resubmit form after MESAV reflects the appropriate coverage by the eligibility worker. Click resubmit form after MESAV reflects the appropriate coverage by the eligibility worker. Click resubmit form after MESAV reflects the appropriate coverage by the eligibility worker. NF Provider Enhancements Page 28 Last Updated: April 1, 2009

29 Frequently Asked Questions 3618 and 3619 Submission Validation Related Questions: Q1. When will the new form sequencing validation edits be completed? A1. The new sequencing validation edits were effective November 14, These validations against the 3618 and 3619 form for sequencing rules occur in real-time when the provider clicks the Submit Form button. Q2. How do I know I have a form sequencing error? A2. When the provider clicks the Submit Form button, form sequencing validations will occur. If there is a form sequencing error, the error will display at the top of the portal page with the specific error. The form will not successfully submit and create a DLN if there is a form sequencing error to be resolved. Q3. Do I have to completely reenter the 3618 or 3619 form if I get a sequencing error since I can t get the form submitted? A3. No, providers do not need to reenter the form. The provider should: 1. Save as Draft the form getting sequencing errors 2. Perform the necessary actions to resolve the issue(s) 3. Retrieve the original form receiving the errors thru My Saved Drafts 4. Click Submit Form button. 5. If there are still outstanding issues, follow the same process steps 1 4 above until form is successfully submitted. Q4. What do I do if it is determined the form getting the real-time sequencing errors does not need to be submitted after all? A4. Assuming the form was never successfully submitted and saved as a draft, delete the draft. To delete a saved draft form the provider should: 1. From the blue bar, click My Drafts 2. Find the draft to be deleted. 3. Click the Remove option. Provider Workflow Related Questions: Q5. How do I know if I have something in the Provider Workflow? A5. Using Forms Status Inquiry, search for those assessments/forms with a status of Provider Action Required. Forms 3618, 3619, MDS and MDSQTR are the types of forms which will end up in the Provider Workflow. Detailed step-by-step instructions for finding items in the Provider Workflow can be found here. NF Provider Enhancements Page 29 Last Updated: April 1, 2009

30 Q6. How do I get an assessment/form out of the Provider Workflow? A6. Once you have found those items in your workflow, they can be moved out of the Provider Workflow by clicking one of the buttons and completing the associated actions. The options are: Correct this form, Inactivate Form or Re-submit to SAS. Correct this form changes the status from Provider Action Required to Corrected. Inactivate Form changes the status from Provider Action Required to Form Inactivated. Re-submit to SAS changes the status from Provider Action Required to SAS Request Pending. Other Questions: FAQ website Q7. I don t understand all the portal statuses that I m seeing on my assessments/forms. A7. The portal statuses can be found by clicking here. Refer to the TILES to RUGS FAQ website for more FAQs. Additional Assistance Contact TMHP Helpdesk at or Option 1 for further assistance with Form Sequencing Validation edit assistance or Provider Workflow assistance. NF Provider Enhancements Page 30 Last Updated: April 1, 2009