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Create a new service agreement

Page posted: 8/3/26

You can use action code A (add) to create an initial service agreement with:

· Authorization type T (which is always the authorization type for home and community-based services [HCBS] program agreements).

· Applicable agreement type to identify the person’s program. For a list of the agreement type codes for each HCBS program, refer to MMIS LTSS Manual – About the service agreement.

You can also use action code A to create a new service agreement by copying from a saved service agreement.

This page includes instructions to:

· Create an initial service agreement.

· Create a new service agreement by copying.

Note: This page does not include instructions for using action code C (change). You can only use action code C to update existing, saved service agreements. You might need to use action code C to resolve exception codes (i.e., edits) on suspended or partially suspended service agreements, or to make changes to the services authorized. For more information, refer to MMIS LTSS Manual – Change an existing service agreement and MMIS LTSS Manual – Close a service agreement.

Create an initial service agreement

To create an initial service agreement:

1. Log into MMIS.

2. Type X at prior authorization on the main menu.

3. Press the transmit key to open the AKEY (key panel) screen.

4. Enter A (add) in the action code field.

5. Enter T in the authorization type field.

6. Enter the letter for the appropriate agreement type based on the person’s program.
Note: Do not enter any additional information on the key panel screen.

7. Press the transmit key.

The first screen that appears is the ASA1 screen.

Complete the ASA1 screen

When the ASA1 screen opens, you will notice:

· The status is suspended.

· The agreement type is copied from the AKEY (key panel) screen.

· The F (function key) line does not automatically show at the bottom of the screen. Press F1 to show the F keys that will be available for use; press F1 again to hide this information.

To complete the ASA1 screen:

1. Enter the AGMT START/END DT (agreement start and end dates), also called the header dates. The dates:

· Must fall within a program eligibility time period (span).

· Cannot exceed 365 days.

2. Enter the person master index (PMI) number in the RECIP ID field. You do not need to enter the person’s name. MMIS will populate that field.

3. Enter the person’s date of birth (DOB). The DOB must:

· Include all four numbers for the year (MMDDYYYY).

· Match the birth date in the recipient subsystem.

4. Add the case manager's provider number (CM NBR/NAME). This number does not have to match the one shown on the screening document. It should be the current case manager assigned to the case. You do not need to enter the case manager’s name. MMIS will populate that field.

These are the only fields you need to complete on the ASA1 screen. Other fields are populated from the recipient subsystem or the screening document.

When you are ready to move to the ASA2 screen, press the transmit key.

Complete the ASA2 screen

To complete the ASA2 screen:

1. Enter Y or N in the PCA COMPLEX field. This field is required on all HCBS service agreements. For more information, refer to MMIS LTSS Manual – HCBS service agreements with PCA complex (enhanced rate) or PCA shared services.

2. Enter reason codes in the STAT RSN field, as applicable. Reason codes are not required but may be helpful. For a list of codes and their related messages, refer to MMIS LTSS Manual – Service agreement reason codes.
Note: When you enter reason codes on the ASA2 screen, MMIS will add the related messages to the letters for all providers, the person and the case manager.

3. Enter Y or N in the SEND RECIP LTR field.
Note: If you type N in this field, MMIS will not mail the MMIS-generated letter to the person. You must provide another equivalent notice and description of the service authorization.

4. Enter the Alternative Care (AC) fee information, if applicable. It is a mandatory field if the service agreement is for a person using AC. For more information, refer to MMIS LTSS Manual – AC fees and service agreements.

5. Enter the Tribal Nation code in the SACTAD field, if applicable. Only Tribal Nations use this field.

6. Enter an agency queue code (OVR LOC) if the service agreement needs to be routed for review/approval by DHS or a county/Tribal Nation.

7. Complete the three fields about the responsible party if the authorization includes personal care assistance (PCA) services:

· Enter Y or N in the RESP PARTY field.

· Enter Y or N in the LIVES WITH RESP PARTY field.

· Enter the name in the RESP PARTY NAME field.

8. Complete the EXCLUDED TIME field, if applicable. It is a mandatory field for Brain Injury (BI), Community Alternative Care (CAC) and Community Access for Disability Inclusion (CADI) service agreements if CDCS T2028 is included on the agreement. Leave this field blank for AC, Essential Community Supports (ECS) and Elderly Waiver (EW) service agreements.

Check for exception codes on the ASA1 and ASA2 screens

DHS strongly recommends checking for exception codes on the ASA1 and ASA2 screens before you enter line item service information on the ASA3 screen(s).

To display exception codes on the ASA1 and ASA2 screens:

1. Press F9 to view any resulting exception codes at the bottom of the screen. Be aware that:

· Exception code 140 (header status is suspended) will always post and will remain until you change the header status later.

· Exception code 157 (line item count is zero, suspend) will always post because you have not completed any line items on the ASA3 screen at this point.

2. Resolve exception codes.
Note: If any exception codes are set to deny based on information entered on the ASA1 or ASA2 screens, do not save the service agreement if you cannot resolve them. Any exception code with a denied status related to information on the ASA1 or ASA2 screen that cannot be resolved will deny the entire service agreement if saved. You cannot change or delete denied service agreements. For more information, refer to MMIS LTSS Manual – Cancel a service agreement.

3. Press the transmit key to open the ASA3 screen so you can enter line items.

Complete the ASA3 screen

Line items represent different services to the ASA3 screen. The cursor will skip over fields that are not needed for waiver, AC and ECS service agreements when you use the tab key.

For each line item you enter, you must have information about:

· Proposed provider and provider number.

· Procedure code.

· Modifiers, if any.

· Dates of service.

· Number and type of units approved.

· Rate and type (i.e., source) of the rate.

For more detailed information about the fields on the ASA3 screen, refer to MMIS LTSS Manual – Service agreement fields.

LTSS Service Rate Limits, DHS-3945 (PDF) includes procedure codes and modifiers used for services available under the waiver, AC and ECS programs. It contains information about:

· Type of unit used for each service (e.g., 15-minute unit or per waiver year).

· State-established rate per unit, when required.

· Service rate maximums, when applicable.

· Services with no published maximum rate.

Notice that each line item starts with LI in the left column. Under LI, you will see line item numbers 01 and 02 on the first ASA3 screen opened. MMIS will only display two line items on each screen.

To complete the ASA3 screen:

1. Only type a description of item(s) to be authorized in the COMMENTS/PROCEDURE DESCRIPTION field when a line item will include any of the following:

· Specialized supplies and equipment (E1399 or T2029).

· Moving Home Minnesota (MHM) tools and equipment for employment (T1999 U6).

· MHM supplies and equipment (T2029 U6/NU, U6/RR or U6/RB).

Use the DHS comment screen if you need more room to provide a complete description. For more information, refer to MMIS LTSS Manual – Authorize services that require additional steps.

2. Tab to the PROC field and enter the procedure code. MMIS will populate the description of the service in the COMMENTS/PROCEDURE DESCRIPTION field based on the procedure code you enter (except for services listed in step 1) when you move to the next screen or when you check for exception codes.

3. Enter modifiers, if necessary, under MOD1-4. You can add up to four modifiers, using the tab key to locate each field.

4. Skip the REV, DRUG and DNES fields. Those fields are protected, so you cannot enter data.

5. Complete the ORDER NPI field for the referring provider for skilled nursing visits, home health aide and extended home care services. For all other services, leave this field blank.

6. Enter the start and end dates for the services. These dates must fall within the header start and end date on the ASA1 screen.
Note: If you do not enter dates on a line item, MMIS will auto-populate the dates to match the dates on the ASA1 screen using the AGMT START/END DT (header dates).

7. Enter a dollar amount in the REQ RATE/UNIT (requested rate per unit) field.
Note: When using this field, the REQ TOT UNITS field must also have a value for services that have a state-established rate per unit.

8. Complete the appropriate REQ TOT UNITS/AMT field:

· For services that have a state-established rate per unit, enter the total number of units requested at the first field within the REQ TOT UNITS/AMT field. MMIS will calculate and auto-populate the dollar amount (AMT) field by multiplying the requested rate per unit by the number of units entered in REQ TOT UNITS.

· For services that do not have a state-established rate per unit on LTSS Service Rate Limits, DHS-3945 (PDF), tab past the first field within the REQ TOT UNITS/AMT field and enter a requested dollar amount in the AMT field.

9. Enter the provider number at PROV NBR/NAME. You do not have to enter the provider’s name. MMIS will auto-populate this information from the provider subsystem.

10. Complete the SHR field for line items with PCA services to identify that the PCA worker or home care nurse will provide services to more than one person at the same time in the same setting. Enter Y if the person’s support plan includes shared care. Otherwise, leave this field blank.
Note: DHS is working to add CFSS information to this manual.

11. Complete the FRQ field for line items that use procedure code T1019. This field will place text on the service agreement letter for line items with T1019 without modifier UC or UA. You can use the following values:

· 1: Daily restricted PCA (used with T1019 and T1019 UC).

· 2: Weekly (used with T1019 UA).

· 3: Monthly (used with T1019 UA).

· 5: Flexible use PCA (used with T1019 and T1019 UC).

12. MMIS compares the rate you entered in the REQ RATE/UNIT field in step 7 to the rate file for the service on the MMIS reference subsystem. The following situations may occur, depending on the service and where the rate is stored in MMIS, for the APP RATE/UNIT and SRC (source) fields:

· If the rate in the REQ RATE/UNIT field matches the statewide rate in MMIS, MMIS will populate the APP RATE/UNIT field to match the REQ RATE/UNIT field. MMIS will also populate the SRC field.

· If the requested rate in the REQ RATE/UNIT field is higher or lower than the statewide rate, MMIS will populate the APP RATE/UNIT with the statewide rate. MMIS will also populate the SRC field.

· If you enter an amount in the REQ RATE/UNIT field and the amount does not exceed the maximum amount for services with rates in the PDDD file for the service, MMIS will populate the APP RATE/UNIT with the amount you entered. MMIS will also populate the SRC field.

· If you enter a rate for a service that can be manually priced (e.g., residential services or respite in a certified facility) in the REQ RATE/UNIT field, MMIS will populate the APP RATE/UNIT with the rate you entered. You must change the SRC field to MM.

Note: You do not enter data in the TOT USED UNITS/AMT field when you are creating a service agreement. This field contains two separate fields that change as claims are paid against the line, showing units used and dollars paid over time.

13. Complete the STAT CD field for the status of each line item. Each line begins with a status of S (suspend). Statuses are:

· A (approved): This status indicates the service is approved and authorized.

· P (pend): This status does not fully approve the line item and will generate a letter to the provider. It is commonly used with reason codes to explain what the provider might need to do to gain final approval.

· D (deny): This status indicates there is no authorization or provider payment attached to this line item.

· S (suspend): This status does not fully approve the line item and will not generate a provider letter. This is the default status when entering line items unless you change the status.

14. MMIS populates the DATE field for the effective date of the status when you press F9 to display exception codes for the line item and/or service agreement.

15. Add up to four reason codes for each line in the RSN CD field. Each reason code has a message associated with it. When you add a reason code on the line item, the message will appear on the service agreement letters to the provider on that line item. For the list of codes and related messages, refer to MMIS LTSS Manual – Service agreement reason codes.

16. Skip the RFE and CTY fields. These fields are protected and only completed for chemical health service agreements.

17. Use the RPT (repeat) field, as necessary. This field allows you to copy the line item the number of times you indicate in the field. The repeated line item appears at the end of the existing line items.
Note: You most often use this field when you are changing a service agreement. When you create a new service agreement, you might use this field when more than one provider will deliver the same service but at different periods or using a different rate. In this case, you can copy the line item and change the provider number and the rate and/or period on the new repeated line.

18. Press F9 when you complete each line item. This is a recommended step that allows you to see any exception codes related to a particular line item before you add another line item.

19. Resolve exception codes. For information about reviewing and correcting service agreement exception codes, refer to MMIS LTSS Manual – Service agreement exception codes.

20. Press F9 after resolving each exception code. In some cases, resolving one exception code will resolve another related exception code.

21. Add more line items. After completing the first two lines on the ASA3 screen, press F11 to open additional lines for data entry, then follow steps 1-20 above.

After you are done adding line items and resolving exception codes:

1. Press F9 to display exception codes for the entire service agreement.

2. Resolve exception codes.

3. Press F9 after resolving each exception code. In some cases, resolving one exception code will resolve another related exception code.

4. Change the status of each line item, as needed.

5. Change the header status, as needed:

· A (approved): Line items can be a combination of approved, denied or pended status, with at least one approved line item. MMIS will generate letters.

· T (partially suspended): Line items can be a combination of statuses. Use T status if at least one line item status is S (suspended) and at least one line item status is A (approved). MMIS will generate letters for all line items except suspended ones.

· S (suspend): Line items can be a combination of all statuses. This status will not allow MMIS to generate letters.

· D (denied): This status indicates the entire agreement is denied. MMIS will change all line item statuses to D as well. You might use this status if, upon completion of the service agreement, MMIS is posting major exception codes. Alternatively, you can press F6 to exit without saving the service agreement.

6. Notice the changes to the ASA1 screen. MMIS calculates and populates the TOT AUTH AMT field on the ASA1 screen using the units and rates from all line items on the ASA3 screen(s) that are not denied. For AC, ECS and EW, the ASA1 screen will also have an amount in the CAP AMT field. The TOT AUTH AMT on the ASA1 screen cannot exceed the CAP AMT on the ASA1 screen for these programs.

7. Press F3 to save and exit the service agreement and return to the AKEY (key panel) screen. Save the document even if there are remaining line item exception codes. When you save the service agreement in suspended or partially suspended status, you can return to it using change mode to finalize and approve the service agreement.

8. Press F3 again to exit the prior authorization subsystem and return to the MMIS main menu.

Create a new service agreement by copying

You can use the “copy from” field on the service agreement AKEY (key panel) screen to copy the ASA1 and ASA2 screens from a previously saved service agreement to a new service agreement.

To use this feature:

1. Log into MMIS.

2. Select prior authorization from the main menu.

3. Press the transmit key.

4. Enter A in the action code field on the AKEY (key panel) screen.

5. Enter T in the authorization type field.

6. Enter the AGMT TYPE (service agreement type) code of the agreement you are copying.

7. Enter the authorization number of the service agreement you are copying in the COPY FROM field.

8. Press the transmit key to open a new service agreement with all fields populated from the copied agreement on the ASA1 screen except the header start and end dates.

9. Review the information and update it as needed.

10. Enter the header start and end dates.

11. Press the transmit key to open the ASA2 screen. All fields are copied except for some of the AC fee fields.

12. Review the information and update it as needed.

13. Press F9 to display exception codes.
Note: This step is not required, but DHS strongly recommends reviewing ASA1 and ASA2 exception codes before moving to the ASA3 screen.

14. Resolve exception codes.

15. Press the transmit key to open the ASA3 screen. The ASA3 line items are blank when copying from a previously saved service agreement.

16. Complete service line items as needed on the ASA3 screen, following the steps in the create an initial service agreement section above.

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MMIS Long-Term Services and Supports Manual