State Reports

Reports to MCOs and Counties

The Department is responsible for communicating enrollee information to MCOs and counties via the following reports:

Report ID	Report Name	Report Distribution	Production Schedule	Report Purpose
MW0417	PPHP Fatal Edit Exclusion Report	Counties	Monthly, on the 1st or 2nd day of the month	To identify to the county recipients with an exclusion span closed due to no longer meeting the exclusion they are coded as in MMIS. Exclusions closed due to death will also be listed on this report.
Data Warehouse	Managed care Maxis/MMIS Reconciliation Report	Counties	Fourth day of the month	To identify discrepancies between MMIS and MAXIS for enrollees to prevent capitation payments to the MCOs.
MW0419 MW0420 MW0421	Nursing Home Prepaid Health Plan Report	Counties MCOs LTC Providers	Monthly, on the 11th of the month	To identify nursing home residents so each entity can best serve enrollees for the next month (schedule appts, provide advocacy, etc.)
MW0426 MW0517	PPHP Open Enrollment Letter Summary PPHP One Plan Open Enroll. Letter Report	Available to counties on Infopac	Yearly	To identify cases for open enrollment mailing for counties with MCOs. To identify cases for open enrollment mailing in counties with one MCO.
MW0500	PPHP New Enrollee Report	DHS	At capitation and at reinstatement	To identify new enrollees for next month (these enrollees will also have Current Enrollment Records)
MW0501	PPHP Disenrollment Report	DHS	At capitation	To identify enrollees with MCO enrollment ending effective the last day of the month.
MW0502	Enrollment Change Report	DHS	At capitation and at reinstatement	To identify current enrollees for the present and next months who had a change in at least one of the data elements on the record (will also have a Current Enrollment record)
MW0503 MW0504	Current Enrollment/ Managed Care Reinstatement	DHS Counties	At capitation and at reinstatement	To identify enrollees for next month, either new or continuing (at cap), new or reinstated (at reinstatement)
MW0506	Potential Enrollee Report	Counties	At capitation and at reinstatement	To identify recipients who are not enrolled or excluded on RPPH. Recipients with YY or WW exclusion with a tracking span over 90 days old are listed on this report.
MW0507	MSHO/SNBC New Enrollee Report	Counties	At capitation	To identify new MSHO/SNBC enrollees for next month.
MW0510	Pre-Capitation Error/ Recipient Capitation Error	Counties	At pre-cap: 7th working day of the month and at capitation	To identify enrollees with RPPH enrollment span closing for next month; county reviews prior to enrollment cutoff or reinstatement to make updates for recipients whose enrollment should continue.

Report Detail

Following are the data elements found on each report.

Fatal Edit Exclusion Report MW0414

The Fatal Edit Exclusion Report is sorted by servicing county and worker id. The report contains the following data elements:

Service Location	Worker ID	Case Number	Recipient ID (PMI)
Exclusion Reason	Exclusion Begin Date	Exclusion End Date

Associated with this report is a batch process that runs on the first working day of the month. This program closes invalid exclusions, that the system can edit against, adds exclusions, and closes the exclusion when the recipient has died.

Invalid exclusions that the system can edit against are closed using the last day of the previous month. Recipients with open eligibility, who have their exclusion closed, will appear on the MW0506 Potential Enrollee report at the next capitation, if they have not been enrolled or excluded.

This program will also add exclusions effective the first day of the current month. The exclusion hierarchy is used. If there is an existing exclusion, and the recipient qualifies for an exclusion higher in the hierarchy, the current exclusion will be closed and the new one added effective the fist day of the current month.

Exclusions closed due to death will be closed using the last day of the month in which that person died. All future spans will be deleted.

Nursing Home Report (MCO/Nursing Facility/County) MW0419/420/421

This is a monthly report that identifies all managed care enrollees for the upcoming month who are residing in nursing homes. There are three versions created each month; one sorted by nursing facility, one by MCO, and one by county. The Nursing Home Report is created on the 11th of the month. Listed below are the data elements contained on this report.

Recipient Name	PMI
MCO Name	MCO Enrollment Begin Date
Product ID	NF Liability Begin Date
NF Liability End Date

New Enrollee (DHS) MW0500

The New Enrollee Report contains the following data elements:

Recipient ID (PMI)	Recipient Name
Date of Birth	Gender
Medicare ID	Social Security Number
Date Added	Enrollment Begin Date
Enrollment End Date	Other Insurance
Pregnant	Interpreter
Language Code	Medical Clinic
Dental Clinic	PCUR Indicator
SPMI Indicator	Rate Cell
Rate	Restricted Begin Date
Restricted MCO	Ethnic Code
Race Code	RCC ID
RCC Begin	RCC End
NF Liability Applies	NF Liability Begin
NF Liability End	Waiver Type
Waiver Begin Date	Waiver thru Date (End)
Recipient Language Code	Indian Health Services
Social Worker	Financial Worker
LTC Ineligible Type	LTC Ineligible Begin
LTC Ineligible End	Nursing Home (Name)
Nursing Home Begin Date	Nursing Home End Date
Hospice Begin	Hospice End
Medicare Part A Begin Date	Medicare Part A End Date
Medicare Part B Begin Date	Medicare Part B End Date
MMIS Address	Phone Number
Case Address	Case Phone Number
Case Number	Case Household Name
Application Date	Begin Date
Major Program	Eligibility Type
Servicing County	County of Residence
TPL Policy Number	TPL Group Number
TPL Carrier Number	TPL Carrier Name
TPL Coverage Type	Authorized Representative Data
Foster Care Indicator

Disenrollment (DHS) MW0501 and Enrollment Change (DHS) MW0502

The data elements found on this report are:

Recipient ID (PMI)	Recipient Name
Case Number	Social Security Number
Case Begin Date	Case End Date
Date of Birth	Age
Medicare ID Number	MCARE
Major Program/Eligibility Type	Living Arrangement
Last Cap Payment Date	Gender
County of Residence	Service Location
LTC Ineligible Begin Date	LTC Ineligible End Date
Date of Death

Current Enrollment/Reinstatement for Provider (DHS) MW0503

The Current Enrollment Report contains the following data elements:

Recipient ID (PMI)	Recipient Name
Case Number	Social Security Number
Date of Birth	Age
Medicare ID Number	MCARE
Living Arrangement	Last Cap Payment Date
Gender	MCO Begin Date
MCO End Date	Rate Cell
Major Program/Eligibility Type	County of Residence

Current Enrollment/Reinstatement Report for Worker (County/MCRE) MW0504

This report is sorted by servicing county and worker ID. The data elements contained on the Current Enrollment Report are:

Recipient ID (PMI)	Recipient Name
Case Number	Social Security Number
Service Location	Gender
Date of Birth	Age
Medicare ID Number	MCARE
Major Program/Eligibility Type	Living Arrangement
Nursing Home Indicator	MCO Number
Last Cap Payment Date	MCO Begin Date
MCO End Date	Rate Cell
County of Residence	Provider Number

Potential Enrollee (County) MW0506

This report identifies recipients who do not have a MCO enrollment or an exclusion span on RPPH. Recipients with a YY or WW exclusion with a tracking span (RTRK) over 90 days old are listed on this report. This report is sorted by servicing county and worker id. The data elements on this report are:

Case Number	Recipient ID (PMI)
Recipient Name	Date of Birth
Gender	County of Service
County of Residence	Major Program/Eligibility Type
Exclusion Code	Exclusion Begin Date
Exclusion End Date

A tracking program runs on the first working day of each month that will begin a tracking span for any recipient that is not enrolled or excluded from managed care and either does not have a tracking span or the tracking span is older than 90 days. The tracking contact type indicator will be “O”.

Pre-Capitation/Capitation Error Report (County/MCRE) MW0510

This report is sorted by servicing county and worker ID. The data elements are:

Case Number	Recipient ID (PMI)
Recipient Name	Date of Birth
Age	Gender
Medicare ID Number	MCARE
Major Program/ Eligibility Type	County of Residence
Living Arrangement	Last Cap Payment Date
Eligibility Begin Date	Eligibility End Date
PPHP Begin Date	PPHP End Date
Contract Number	Product ID
Error Reason	Number of recipients in error by case

Remittance Advice (MCO)
A remittance advice is available biweekly to all MHCP providers (including MCOs) who have MMIS payment activity during the preceding two weeks. If the payment activity results in an amount owed to the provider, or MCO, a warrant is issued.

Capitation payments for a given month (as well as reinstatements for the previous month) will generally appear on the first remittance advice that follows the capitation run. Other payments or claims activity that may appear on any remittance advice includes gross adjustments, capitation payment adjustments (recoveries), suspended and denied capitation claims.