Q. What should I do if I transfer a member in error?
A. You should contact the board where the client was enrolled prior to the erroneous transfer and work with them to have the client reinstated in their group and plan.
Q. When is it acceptable to have a gap in a client's eligibility spans?
A. If the client was a resident of Ohio, moved out of state and then moved back to Ohio.
Q. Can a client request to be removed from MACSIS?
A. Yes. There are certain conditions and a process for when a client can be removed from MACSIS. In order to be removed from MACSIS, the client enrolled must have no claims in the system or the client has received services but they have not been paid in whole or part with public funds. Refer to the Removal of Client Data from MACSIS for information concerning the conditions that must be met and the process to get the client removed.
Q. When a board receives a new member enrollment form for a Medicaid or Non Medicaid client that has a retroactive (non-current) effective date, what effective date do/can they use?
A. When a Board receives a new member enrollment form for a Medicaid or non-Medicaid client that has a retroactive (non-current) effective date, the client should be enrolled as of the effective date on the new member enrollment form, but no more than 365 days retroactive from the current date.
Q. Are boards able to initiate transfer requests?
A. Boards are encouraged to work together to make sure clients are enrolled in the correct county of residence. In most cases providers initiate transfers when they submit a new member enrollment form to an out-of-county Board. Boards should no longer be using extracts to notify other Boards that they need to move members.
Q. What to do when boards refuse to accept "Residency Verification" form and say they need more proof?
A. Boards should not refuse to accept the "MACSIS Out-of-Service Area Residency Verification" form as a proof of residence for out-of-service area enrollments and should not request additional proof of residence if this form has been supplied. If a Board fails to follow proper procedures a provider may contact MACSIS Support.
Q. Can a Board refuse to enroll a client?
A. A Board may refuse to enroll a client if the client is non-Medicaid, is receiving non-crisis services and the Board will have no financial responsibility towards this client because the client will not be funded In Whole or In Part with public funds.
Q. Should Boards be terming members? If so, when is it acceptable to term a member? What reason codes should be used?
A. The only acceptable times a board can term a member is if the member is deceased (MBDEC), moved out of state (MBMOS), or is no longer income eligible (MBINL). If a non-MCD client is termed with any reason code other than the three above or the State EDUP1, EDUP2, EDUP3, PREGL or ERR01codes, the span will automatically be reopened and the term reason removed.
Q. What services are supposed to be billed under a pseudo client UCI?
A. The only services that are to be billed under pseudo clients (UCI's) are those services that are non-client specific (services that are not limited to a single member at a time, i.e. such as Community Education or Drug and Alcohol prevention). Note: Pseudo UCI's should not be used to enroll a client who is in crisis. The correct procedure for enrolling a client that is in crisis and unable to give you the necessary information is: Obtain the last name, first name, gender (guess- if not obvious), SSN (if you can't get it use 555-55-5555, date of birth (if you can't get it use 07041876 (used to be 07041776) or another date defined by your Board).
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Q. Are some crisis centers exempt from obtaining the "Residency Verification" form?
A. No, the only form that is needed to enroll a client in crisis who is unable to sign the other required forms is a new member enrollment form. The other forms must be completed once the client is no longer in crisis. Crisis centers are not exempt from getting the necessary forms signed, once the client is no longer in crisis. This includes the "MACSIS Out-of-Service Area Residency Verification" form.
Q. Can a Board use/develop a "Residency Verification" form to be used for clients within their own area?
A. Board may use/develop a "Residency Verification" form to be used for clients within their own service area as proof of residency. Use of one does not supersede their local Board policies regarding proof of residence. The MACSIS Support Help Desk will use the Enrollment form and the standard "Residency Verification" form located on the MACSIS web site for the enrollments they perform.