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MACSIS Naming Conventions

Last Revised Date: 8.20.2004

PURPOSE: The purpose of this document is to identify the naming convention, which should be followed by all boards. Although the boards are able to implement the system to meet their own needs, please follow the structure below. If there are any questions, please contact MACSIS Support.

Keywords are maintained by the state. Any requests for changes must go through the proper change control channels.

If you want to default the start date within a keyword to an earlier date, use 01/01/1901.

Use 01/01/2010 to default to a future date, if required.

KEYWORD DESCRIPTION MACSIS PURPOSE STRUCTURE
COMPF

Company Code

Identify board or group of boards

Characters 1-4: 1st 4 letters of board or group of boards

Character 5:

  • M for MH boards
  • A for ADAS boards
  • B for ADAMH boards

e.g. SUMMB for SummitCounty

*LINBS Line of Business Statewide Use

MCD = Medicaid

NON = Non-Medicaid
BANKA Bank Account See COMPF
GLREF G/L Reference Codes Expensing of claims

Must have at least 5 codes representing:

  • MH Medicaid (ex. MMH)
  • AD Medicaid (ex. MAD)
  • NMH Non-Medicaid (ex. NMH)
  • NAD Non-Medicaid (ex. NAD)
  • DEFDefault (ex. DEF)

Can define further at local level if desired.

GROUP Group Code Identify County

Group Level 3: 1st four characters of county name (e.g. WARR)

Group Level 2: Board Name (eg. Warren/Clinton)

Group Level 1: Name of board or consortium (e.g. BHG)

PLANC Plan Code Identify Board Specific Plans

1st two characters identify service type:

  • MH - Mental Health
  • AD - Alcohol & Drug
  • DF - Dually Funded

Characters 3-5 identify Medicaid status:

  • MCD - Medicaid eligible
  • NON - not Medicaid eligible

Characters 6-7 identify board number:

e.g.:25=Franklin/ 48=Lucas

Characters 8-10 are reserved for county use

Examples:

MHMCD25XXX - Mental Health Medicaid FranklinCounty SMD

ADNON25XXX - AOD Non-Medicaid Franklin County SMD

PANEL Provider Panel Identify those all panels for which a provider is associated

1st two characters = board #

3rd character = board type

  • M - Mental Health
  • A - ADAS
  • B - ADAMH
  • D - Dually funded

***other codes besides “M, A & B” are reserved for local use; AOD codes are limited to A-L, MH are limited to M-Z; it is recommended that Dual-funded panels begin with D.

IPA Provider IPA Used only in capitation
*REASN Reason Codes Identifies various types of reason codes. Reason Codes are shared statewide. Any changes or additions must go through change control
*PSCHD Price Schedule Used to connect the provider contract with the procedure price

Each provider will be assigned 5 price schedules:

3 primary price schedules for Medicaid reimbursable services

  • Begin with either a 0, 1 or 2

2 alternate price schedules for Non-Medicaid reimbursable services

  • Begin with either an A or B
REGIN Price, Service and Geographic Regions For Price Region, used in conjunction with PSCHD to identify the fee schedule. Since PSCHD naming is generic, Region ties the PROCP record back to the board

1st two characters = board #

3rd character = board type

  • M - Mental Health
  • A - ADAS
  • B - ADAMH
  • D - Dually Funded

***other codes besides “M, A & B” are reserved for local use; AOD codes are limited to A-L, MH are limited to M-Z; it is recommended that Dual-funded panels begin with D.

*PRULE Price Rule

Price Rules are attached to the provider contract (PROVC) and identify the pricing method for each procedure code.

PRULE 1 will always be used for professional pricing.

PRULE 2 will always be used for institutional pricing.

PRULE 1 will always be OH. It identifies all of the procedure codes to be paid at fee schedule.

PRULE 2 must be maintained at the local level because the method of paying institutional claims differs by board.

*RIDER Rider

Attached to a member’s eligibility period when the member qualifies for a sliding scale.

If a sliding scale rider is attached in Member, a BRULE must be attached to the BENEF record. The BRULE will identify the amount of the sliding scale and MUST have the corresponding RIDER code indicated in the rider column.

Riders 0-9 will be used to identify specific co-pay amounts.

Riders A-S identifies sliding scale percentages in 5% increments. Boards/consortiums are limited to the codes listed, but can use the codes as needed within their groups. However, they must use the codes consistently within their group.

  • A- 5%
  • B - 10%
  • C - 15%
  • D - 20%
  • E - 25%
  • F - 30%
  • G - 35%
  • H - 40%
  • I - 45%
  • J - 50%
  • K - 55%
  • L - 60%
  • M - 65%
  • N - 70%
  • O - 75%
  • P - 80%
  • Q - 85%
  • R - 90%
  • S - 95%
  • Z - 0%
  • T-Y reserved for local use
  • 1-9 reserved for local use
Benefit Rule BRULE

Benefit types are attached to the BENEF causing Diamond to apply certain benefits during claims adjudication.

Examples of BRULE types are coinsurance or sliding scale, exclusions, message and pend, limit and copay.

If a particular service requires authorization a BRULE is attached to the BENEF indicating the requirement.

Characters 1-2 :Board Number

Character 3: Board type or diagnosis type. Valid codes are:

  • M - Mental Health
  • A - ADAS
  • B - Combined
  • D - Dually Diagnosed

Characters 4-10: available for local use

Boards may want to use statewide sliding scale rules (associated with rider codes), which all begin with OH.

Any further description given in the name will only assist the boards in clarifying information.

Six BRULES must be included in ALL benefit packages, both Medicaid and non-Medicaid:

  • ADMCDDDAYS - this rule limits AOD Medicaid Day Services (Ambulatory Detoxification and IOP) To One Per Day
  • ADMCDOUTP1 - this rule limits AOD Medicaid 15 Minute Outpatient Services to 96 Total Units (24 Hours) Per Day
  • ADMCDOUTP2 - this rule limits AOD Medicaid Hourly Outpatient Services to 24 Total Units Per Day
  • OHINVALID –this rule denies all services with invalid medefs
  • MHPARHOSPA- this rule limits an adult client to 1 unit of partial hospitalization per day
  • MHPARHOSPC – this rule limits two units per day of MH partial hospitalization for kids.
*Providers PROVF One UPI number allowed per provider. Exception: Multiple UPI’s allowed for provider with different location and different rate. The provider id (i.e., UPI) will be a five-digit number assigned by MOM.
Security Flag SOVER One security flag allowed per group of boards One character: To be assigned by MOM