Change an existing service agreement

Page posted: 8/3/26

You can use action code C (change) to update an existing, saved service agreement. The change action code allows you to:

· Resolve remaining exception codes (i.e., edits) on a saved suspended or partially suspended service agreement so you can approve the service agreement.

· Add or revise line items (e.g., add services, units, providers).

· End a service agreement because of changes in the person’s program eligibility or program type. For more information about this situation, refer to MMIS LTSS Manual – Close a service agreement.

For information about how to locate suspended or partially suspended service agreements for review and change, refer to MMIS LTSS Manual – Use inquiry mode with a service agreement.

Service agreement header and line item status

The fields you can change on an existing service agreement will depend on the status of the header and the status of the line items when the service agreement was last saved in MMIS. Fields you can change are green, and fields that are protected and not changeable are white. The statuses are:

· Approved: To have an approved (A) header status, the document must include at least one line item that is also in an approved status. It may also include line items with pend (P) or denied (D) statuses. Line items with an approved status are approved to provide services only after the documents header status is also in an approved or partially suspended status.

· Partially suspended: To have a partially suspended (T) header status, the document must have a combination of line items with pend (P) or suspended (S) and approved (A) statuses. The document may also have line items that are in denied (D) status. Line items cannot have a partially suspended status.

· Pend: To have a pend (P) header status, the document cannot have any approved line items. The document could have a combination of line items with pend (P), denied (D) or suspend (S) statuses. A line item cannot have a pend status when the document has a denied header status.

· Suspended: To have a suspended (S) header status, the document could have a combination of line items with approved (A), pend (P), denied (D) or suspend (S) statuses. MMIS does not issue letters for line items on a document with a suspended header status.

· Denied: To have a denied (D) header status, all line items on the document must also have a denied status. You cannot make changes to any denied service agreement or denied line items.

Change a saved service agreement

To select a service agreement to change services, units, providers, time periods or rates:

1. Log into MMIS.

2. Type X next to prior authorization on the main menu.

3. Press the transmit key.

4. Use action code C on the service agreement AKEY (key panel) screen and the person master index (PMI) number or the service agreement authorization number.

5. Press the transmit key.

If you use the person’s PMI number and the person has more than one saved service agreement, the service agreement ASEL (selection) screen will open.

If you use the person’s PMI number and the person only has one saved service agreement, that service agreement will open at the ASA1 screen.

If you use the service agreement authorization number, that service agreement will open at the ASA1 screen.

Fields you can change on ASA1 and ASA2 screens

On the ASA1 and ASA2 screens, you can only change fields that are green.

Fields you can change on ASA3 screen

On the ASA3 screen, you can only change fields that are green. You can also add additional line items. There are limits to what type or how much information you can change in some fields for line items on this screen.

Change the unit field on a line item

You can increase or decrease units on a line item, within the following rules:

· You cannot decrease the number of units to lower than the number that has already been used in the total units used field.

· You cannot increase the number of units to more than the number allowed within a time period. For example, a line item that includes a daily service with 10 units must have 10 days in the service dates period.

To change the number of units on a line item:

1. Move the cursor to the unit field.

2. Press the end key to delete the current units shown.

3. Enter the new number of units.

4. Press F9 to recalculate the requested total amount based on the new number of units.

MMIS will post an exception code if the increased units put the service agreement total over the Alternative Care (AC), Essential Community Supports (ECS) or Elderly Waiver (EW) total cap amount. To resolve this exception code:

· Compare the total authorized amount field to the total cap amount field on the ASA1 screen.

· Reduce the number of units or deny the status of another line item.

Change the total amount field on a line item

You can increase or decrease the total dollar amount for services priced with a total amount instead of a rate and unit, within the following rules:

· You cannot decrease the total amount below the amount that has been paid, as shown in the total used amount field.

· For AC, ECS or EW, you cannot increase the total amount if it puts the service agreement total over the total cap amount.

MMIS will post an exception code if the total amount puts the AC, ECS or EW service agreement total over the total cap amount. To resolve this exception code:

· Compare the total authorized amount field to the total cap amount field on the ASA1 screen.

· Reduce the total amount field on one or more line items.

Change begin/end dates

You cannot change the header begin date on an approved or partially suspended service agreement.

You can change the header end date or a line item period if services need to continue beyond the initial end of a period. You can also decrease the end dates if the person leaves the program.

The header period:

· Cannot exceed 12 calendar months for waivers and ECS or 365 days for AC.

· Cannot fall outside of the waiver eligibility period (on RWVR screen) or Medical Assistance eligibility period (on RELG screen) in the recipient subsystem.

· Must fall within the AC or ECS eligibility period (on RELG screen) for AC or ECS service agreements.

A line item begin date cannot:

· Be before the header begin date.

· Exceed the header end date.

The service agreement header end date must account for (and cannot be before) any line item end dates. MMIS will post exception code 156 (LDOS/paid claim conflict) if the provider billed for a service date that is after the new end date entered. If this happens and the proposed end date is correct, the provider must complete a credit claim before you close the line item using the correct date. For information about correcting claims, refer to MHCP Provider Manual – Billing policy overview. When appropriate, a provider may rebill under a new service agreement if you create one.

For more information about provider billing, refer to MMIS LTSS Manual – Claims and service agreement corrections.

Change the line item status

You can change the line item status from:

· A (approved) to D (denied) as long as no payments have been made against the line item (i.e., the total used units and total used amount fields are blank).

· P (pend) to A (approved) or D (denied).

· S (suspend) to A (approved), P (pend) or D (denied).

Add a new line item

To add a new line item while on the ASA3 screen:

1. Press F11 to go to the next blank line item.

2. Complete the new line item.

3. Press F9 key to display exception codes for the new line item.

4. Resolve exception codes.

5. Update the status code of the new line item and document header as needed.

Update line item due to rate or provider change

Sometimes, a rate on an approved line item will increase during the period covered in the line item, or a new provider will deliver the service. In this situation, you must either copy the existing line item or create a new line item.

You can choose use the RPT (repeat) field to copy the existing line item if much of the information will be used on the new line item. If you enter 1 in the RPT field and press the transmit key, the copied line item will appear at the end of the existing line items. MMIS will post exception code 876 (line item duplicate) until you change the new line from the copied line.

You must:

1. Update the existing line item end date to the last date the rate or provider will be used.

2. Make the applicable adjustment:

· If the service uses units, adjust the units to reflect the total units needed. This cannot be less than the total units paid.

· If the service was priced with a total amount instead of a rate and unit, increase or decrease the total dollar amount. This cannot be less than the total amount paid.

3. Enter a new line item (or use the copied line item) to reflect the change in rate and/or provider. If the service uses a unit and rate, enter the units and rate to be used in the new time period.

4. Enter the begin date as the first date the new provider and/or rate will be used.

5. Press F9 and resolve any exception codes.

6. Update the status code of the new line item and document header as needed.

End an approved line item due to no claims paid

If no claims should be or have been paid against an approved line item (e.g., service will no longer be provided or was never provided, or the rate and/or provider number is incorrect), you must change the line so future claims will not pay off the line item.

If the line item was priced by a rate and unit, and no units were used or money paid:

1. Delete the units and total amount fields.

2. Change the end date so it is the same as the begin date.

If the line item was priced by a total amount of money, and no money was paid:

1. Delete the total amount field.

2. Change the end date so it is the same as the begin date.

End an approved line item with claims paid

If no additional claims should be paid from an approved line item and the line was priced by a rate and unit, you must decrease the date span and/or the units to match the last date the services were allowed to be provided and or the total units paid field.

If the line item was priced by a total amount of money, decrease the date span and/or the total amount field to match the last date the services were allowed to be provided and or what was paid, as indicated in the total amount paid field.

If you must close the service agreement because the person is leaving the program (including if they change to a different program), follow the instructions on MMIS LTSS Manual – Close a service agreement.

Copy line items

You can copy line items when you change an existing saved service agreement or create an initial service agreement.

You might copy a line item if:

· The provider used all the units before the end of the line item period. In this situation, you add a new line item to restrict the use of units by day, week or month with enough units to cover the selected period.

· More than one provider will provide the same service but at different periods or rates. In this situation, you copy the line and change the provider number, the rate and/or period on the new line.

· You close a line item and enter a new line item to show a change in the rate and/or provider.

· The person enters a nursing facility or residential treatment setting for less than 30 days. In this situation, you close the current line items to the date of admission. When the person returns to the community, you repeat the line items once so the new line items start with the new period if program eligibility remains open.

Instructions

To copy a line item:

1. Go to the line item you want to repeat.

2. Tab to the RPT (repeat) field at the end of the line item and add a number for how many times the line should be repeated.

3. Press the transmit key. Copied line items will appear at the end of all other line items.

4. Press F9. MMIS will post exception code 876 (line item duplicate). This code will disappear when you make changes to copied line item(s).

5. Update each line by changing duplicated field(s).

6. Press F9 after completing each new line item.

7. Review and resolve exception codes

8. Update the line item status code of the new line item(s) and document header as needed.

Deny a line item

There are times when you must set a line item status to deny. To do this, change the line item status to D.

You can erase the provider number field so the provider does not receive a denial letter, or you can keep the provider number and add reason code 841 (this line item is no longer needed) or reason code 983 (this line item is denied because it was entered by mistake or has errors that cannot be corrected) so the message will show on the recipient and provider service agreement letters.

Delete a line item

There are different methods to delete a line item that was entered in error or copied too many times. You should never delete line items that have had claims paid against them or if there are sequential line items on the document that have previously been saved with an approved, pend or denied status. Consider setting a line item to deny status rather than deleting the line item(s).

The delete function for the waiver, AC and ECS service agreement line items is limited to suspended line items and only works when the header status is S (suspend).

To delete a line item:

1. Place the cursor at the beginning of the line item on the service description field of the line item to delete.

2. Enter four periods (. . . .) and press F9. If there were other line items that follow, those line item numbers will change and will affect information on letters to remaining providers.

Additional resources

MHCP Provider Manual – Billing policy overview
MMIS LTSS Manual – Claims and service agreement corrections
MMIS LTSS Manual – Close a service agreement
MMIS LTSS Manual – Use inquiry mode with a service agreement