Begin at the AKEY prior authorization panel to initiate a new Type R or S service agreement (SA) for DD waiver.

Complete MMIS fields using information on the Service Agreement DHS-3070 form. Section and Box numbers on the DHS-3070 form correspond with fields in MMIS. The codes entered in boxes on the form are the same as the valid values entered in the corresponding MMIS field.

MMIS assigns an 11-digit authorization number to the service agreement and automatically populates the authorization number field.

The first four digits of the authorization number are the date staff initiate the SA in MMIS. First number is the last digit of the current year and the remaining three numbers are the Julian date. For example, 1248 is September 5, 2011. The first digit 1 is the last digit of the year 2011. The next three digits 248 are the Julian date or the 248th day of the year.

The authorization number remains the same when updating an existing service agreement.

Enter the service agreement start date (Box 3) in MMDDYY format.

Enter the service agreement end date (Box 4) in MMDDYY format.

New type R-S SA for DD waiver

The SA date span must be within the waiver span dates created by the waiver-in or annual review DD SD. The SA date span can be less than one year but no longer than the end of the 12th calendar month.

Update or close SA for DD waiver

Change the AGMT END date to indicate the last day services recipient may receive services and the last day providers can bill for services.

1. Tab to AGMT END DT field.
2. Press the End key.
3. Enter new end date in MMDDYY format in the AGMT END DT field.

Enter the recipient’s person master index (PMI) number (Box 11). MMIS requires use of the PMI number to identify a person. Conduct a Recipient File search when the PMI number is unknown.

Enter the recipient’s birth date (Box 12) in MMDDYYYY format.

Enter the case manager’s National Provider Index (NPI) number or Unique Minnesota Provider Index (UMPI) number (Box 13) in the CM NBR field.

Leave the CM NAME field blank. MMIS auto-populates this field based on the case manager number entered after F9 key is used.

Enter a Y (yes) or N (no). Y (yes) indicates that the assessor has authorized services.