Service agreement exception codes (i.e., edits)

Page posted: 8/3/26

MMIS may post exception codes (i.e., edits) after you enter a service agreement with data that is invalid, incorrect, incomplete or in conflict with other information in MMIS. MMIS will check the data entered into the service agreement to verify information related to the:

· Person.

· Providers.

· Procedure codes for services and/or modifiers.

· Rates.

· Dates.

· Service agreement type.

· Program eligibility.

· Duplicate or conflicting information.

Exception code statuses

Each exception code has a status code that determines the effect the exception code will have on the service agreement. Status codes may:

· Deny the entire agreement (status code 3).

· Deny a line item (status code 3).

· Suspend the entire service agreement (status code 4).

· Suspend a line item (status code 4).

· Provide information only (status code 6).

Instructions for the ASA1 and ASA2 screens

Check for exception codes on the ASA1 and ASA2 screens before you enter service line items on the ASA3 screen. This will allow MMIS to check entered data against all other applicable subsystems and ensure:

· Mandatory fields are complete and data is valid.

· An open, reopen or reassessment screening document was approved to establish the period of eligibility.

· The service agreement type code entered on the AKEY (key panel) screen matches the program type of the last approved screening document. The service agreement type code is listed at the top on all service agreement screens, including the comments screens.

To check for exception codes:

1. Complete the ASA1 and ASA2 screens.

2. Press F9.

3. Review any resulting exception codes that appear at the bottom of the screen. Note:

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

· Exception code 157 (line item count is zero) will always post because you have not completed line items on the ASA3 screen yet.

· A + (plus) sign at the end of the exception code line at the bottom of the screen means there are more exception codes than can be shown. You can press F7 and F8 to scroll. The cursor does not need to be on the exception code line to press F7 and F8 when you are on the ASA1 and ASA2 screens.

4. Resolve other exception codes before you move to the ASA3 screen.

Correct exception codes on the ASA1 and ASA2 screens

To correct an exception code:

1. Move the cursor to the exception code number.

2. Press F1 to show the title and short description of the exception code.

3. If you need more information, move the cursor to the exception code number and press F4 to view a text file that explains why MMIS posted the exception code and what you need to do to resolve it.

4. Press F3 or F6 to return to the service agreement.

5. Correct the data that triggered the exception code.

6. Press F9 after correcting each exception code. The exception code will disappear if it is resolved.

Instructions for the ASA3 screen

The ASA3 screen is where you complete individual line items to authorize services. DHS recommends you press F9 after entering each line item to check for exception codes. This recommended (but not required) practice makes it easier to correct exception codes because any exception codes that appear will be related to the line item you just entered.

If 00 appears in front of the three-digit exception code number, the exception code applies to the entire service agreement, typically because of an error on the ASA1 or ASA2 screen. Any other number identifies that MMIS is posting the exception code for that numbered line item (e.g., 01-XXX indicates the exception code is related to line item 01).

Correct exception codes on the ASA3 screen

To correct an exception code at the line item:

1. Move the cursor to the exception code number.

2. Press F1 to show the title and short description of the exception code.

3. If you need more information, move the cursor to the exception code number. Press F4 to view a text file that explains why MMIS posted the exception code and what you need to do to resolve it.

4. Press F3 or F6 to return to the service agreement.

5. Correct the data that triggered the exception code.

6. Press F9 after correcting each exception code related to the line item. The exception code will disappear if it is resolved. Note:

· A + (plus) sign at the end of the exception code line at the bottom of the screen signifies that there are more exception codes than can be shown.

· Press F7 and F8 to scroll back and forth to view additional exception codes.

· The cursor must be within the section of the screen containing the exception codes to view additional codes using F7 and F8.

7. Enter additional line items and repeat steps 1-6.

Update the line item status

Once you have entered all line items and resolved all exception codes, you must update the status of each line item.

To update the line item status:

1. Move the cursor to the STAT CD field.

2. Change the letter to one of the statuses in table 1.

Table 1: Line item status codes

Line item status code	Description
A (approved)	The line item is approved. Payments may now be made against the line item. Some fields are protected from further changes. Line items with this status will show on service agreement letters.
D (deny)	The line item is denied. You can ignore any exception codes that post for the line item.
P (pend)	More information is needed before the lead agency can make a decision. Line items with this status will show on service agreement letters.
S (suspend)	No decision has been made. Payments cannot be made against the line item. Line items with this status will not show on service agreement letters.

Update the header status

The service agreement header status field on the ASA1 screen is based on the status across all line items. Once you have resolved all exception codes, you must update the header status.

To update the header status:

1. Type ASA1 in the NEXT field in the upper left corner and press the transmit key.

1. Move the cursor to the DOC STAT field on the ASA1 screen.

2. Change the header status to one of the statuses in table 2.

Table 2: Header status codes

Header status codes	Description
A (approved)	You can use this status with a combination of approved, denied and pended line items. If the status is A (approved), MMIS generates service agreement letters.
D (deny)	When you set the header status to deny, MMIS will automatically change each line item status to deny. You cannot change approved service agreements to the deny status later.
P (pend)	You can use this status when at least one line item is pending. If the header status is P (pend), MMIS does not generate service agreement letters.
S (suspend)	You can use this status when at least one line item is suspended. If the header status is S (suspend), MMIS does not generate service agreement letters.
T (partially suspend)	You can use this status when one or more line items are suspended, and at least one line item is approved. This status will generate letters to providers with approved or denied line items only.

Save the service agreement in MMIS.

After you resolve exception codes and update the statuses within the service agreement, press F3 to save and exit the service agreement. Then, you automatically return to the AKEY (key panel) screen. If the document is properly saved, an “action completed” message will appear.

Do not press F6 to exit. If you do, MMIS will not save any of the data entered into the service agreement you just created.

If you are finished working in MMIS, press F3 to return to the main menu, then press F3 again to log out.

Exception codes related to specific services

Personal care assistance (PCA)-specific exception codes

The following exception codes are specific to PCA services included on service agreement line items.

Note: DHS is working to add information about Community First Services and Supports (CFSS) to this page.

Table 3: PCA-specific exception codes

Exception code	Description
Exception code 858: Frequency period is missing	MMIS will post this exception code if the frequency field is blank for T1019, T1019 UA, T1019 UC, T1019 TG and T1019 TG UC. The value must be 3 (monthly) or 5 (flexible use).
Exception code 889: PCA line > 6 months or > 2 lines	MMIS will post this exception code when either: · The line item has T1019 with no modifier (state plan PCA only) or T1019 TG (PCA complex) and the line item date span is more than six calendar months. · There are more than two line items for the same provider number for T1019 with no modifier or T1019 TG. This exception code does not apply to line items for extended PCA services (T1019 UC).
Exception code 891: Cannot increase units or amount	MMIS will post this exception code when the approved line item has T1019 with no modifier (state plan PCA only) and the units are increased. You must authorize additional units based on a change in assessed needs using a line item with extended PCA (T1019 with modifier UC). If a person is on the Alternative Care (AC) program with PCA services using T1019, you can force this exception code to allow an increase in units. This exception code does not apply to line items for extended PCA services (T1019 UC).
Exception code 442: Procedure not allowed due to PCUR	MMIS will post this exception code if the line item for T1019 with or without modifiers overlaps with a period shown on the RPCR screen.
Exception code 852: PCA supervision is missing/invalid	MMIS will post this exception code if a line item for T1019 with modifier UA is not present when another line item with T1019 is present.

Consumer directed community supports (CDCS)-specific exception codes

For information about exception codes associated with authorizing CDCS, refer to MMIS LTSS Manual – Work with CDCS.

Exception codes related to Medicare

The recipient subsystem shows the most recent eligibility span for Medicare Parts A and B on the RSUM screen. The RMCR screen shows all spans for parts A, B and D. The following exception codes are related to Medicare coverage.

Table 4: Medicare-specific exception codes

Exception code	Description
Exception code 274 (Medicare is present)	MMIS will post exception code 274 on a service agreement to alert you that the person is also eligible for Medicare Part A. This exception code posts once for any line item for a service that may be covered under Medicare Part A. You can force this exception code.
Exception code 388 (Medicare is present)	MMIS will post exception code 388 on a service agreement to alert you that the person is also eligible for Medicare Part B. This exception code posts once for any line item for a service that may be covered under Medicare Part B. You can force this exception code.
Provider claim exception code 237 (Medicare is on recipient eligibility file)	The provider must submit documentation with their claim to show Medicare denial or payment for services listed above that may be covered by Medicare. If the provider does not include documentation with the claim, MMIS will post claim exception code 237 to deny the waiver, AC or home care claim.

Additional resources

MMIS LTSS Manual – Work with CDCS