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DSD MMIS Reference Guide

DSD MMIS Reference Guide


Prior authorization – Service agreements

Page posted: 6/21/11

Page reviewed:

Page updated: 8/10/16

MAIN screen

MMIS stores six different types of prior authorizations in the PRIOR AUTHORIZATION subsystem. This includes documents for medical, dental, medical supplies, pharmacy, inpatient hospital, waivers and other programs. Five of the types are actually prior authorizations and titled as such. The sixth type is the service agreement. MMIS stores two types of service agreements for home and community-based services (HCBS) in the MMIS PRIOR AUTHORIZATION file:

  • · Home care service agreements (CSG, CSG with FSG, home health aide, personal care assistance, home care nursing and skilled nurse visits).
  • · Waiver service agreements (CAC, CADI, DD, EW, TBI and the AC Program).
  • 1. Tab to place the cursor in front of the PRIOR AUTHORIZATION menu item located in the PRIOR AUTHORIZATION APPLICATIONS section on the MAIN MENU screen.
    2. Type the letter X to select the PRIOR AUTHORIZATION file.
    3. Press a transmit key (i.e., the numeric enter key or control key) to advance to the AKEY screen.

    AKEY screen

    Enter a valid value in the ACTION CODE field on the AKEY screen:

  • · A (i.e., add) allows workers with appropriate MMIS security access to create a new service agreement.
  • · C (i.e., change) allows workers with appropriate MMIS security access to make changes to existing service agreements.
  • · I (i.e., inquiry) allows workers to review information only.
  • To review existing prior authorization, complete the following fields:
    1. Type the letter I (i.e., inquiry) in the ACTION CODE field.
    2. Enter the recipient’s PMI (Person Master Index) number in the RECIPIENT ID field. MMIS requires use of the PMI number to identify a person. Conduct a Recipient File search when the PMI number is unknown.
    3. To review all authorization types, leave the AUTHORIZATION TYPE field blank.
    4. When AUTHORIZATION TYPE field is blank, leave the AGMT TYPE field blank.
    5. Press a transmit key to advance to the next screen. If only one service agreement or other prior authorization exists for the PMI entered, MMIS opens the document and does not open the ASEL screen. If no history exists, MMIS displays a message at the bottom of the AKEY screen stating: NO DOCUMENTS MEET THE SELECTION CRITERIA.

    ASEL screen

    If there are prior authorizations for the PMI entered including service agreements, the ASEL screen opens and lists existing prior authorizations for the PMI entered on the AKEY screen. MMIS displays valid values (i.e., codes and dates) that detail the prior authorization history.

    To review a list of prior authorizations in MMIS and select a document to view:
    1. Use the tab key to place the cursor in front of a document on the ASEL screen.
    2. Type the letter X in the SEL IND field to select the document.
    3. Press a transmit key to open the selected service agreement.
    4. Press a transmit key to advance through the queue and review history.
    5. Press function key F6 to return to the ASEL screen to select another document.
    6. Press function key F6 from the ASEL screen to return to the AKEY screen to begin entry of a new service agreement.

    TYPE field valid value T followed by the service agreement type letter code indicates a service agreement.

    AUTH NUMBER field displays the authorization number MMIS assigned to the service agreement.

    ST field displays the status of the service agreement:

  • · A = APPROVED
  • · S = SUSPENDED
  • · D = DENIED
  • START DATE field displays the start date of the service agreement in MMDDYY format.

    END DATE field displays the end date of the service agreement in MMDDYY format.

    MAJ PROG field displays the major program of the recipient at the time of this service agreement.

    Initiate a new service agreement

    Before entering a new service agreement into MMIS, conduct a recipient file search to confirm the person’s eligibility status. Then initiate a new service agreement.

    1. Enter A (i.e., add) in the ACTION CODE field on the AKEY screen.
    2. Enter T (i.e., service agreement) in the AUTHORIZATION TYPE field.
    3. Enter a SA type code in the AGMT TYPE field.

  • · B = Home care service agreement (PCA and CSG)
  • · D = Special needs ICF-DD
  • · E = DT&H pilot ICF-DD
  • · F = CADI conversion
  • · G = CADI diversion
  • · H = CAC conversion
  • · I = CAC diversion
  • · J = EW conversion
  • · K = EW diversion
  • · L = TBI-NF conversion
  • · M = TBI-NF diversion
  • · N = AC conversion
  • · O = AC diversion
  • · P = TBI-HP conversion (TBI-NB)
  • · Q = TBI-HP diversion (TBI-NB)
  • · R = DD conversion
  • · S = DD diversion
  • 4. Press a transmit key to advance to the ASA1 screen and begin data entry.

    Update an existing service agreement

    1. Enter C in the ACTION CODE field on the AKEY screen.
    2. Enter T in the AUTHORIZATION TYPE field.
    3. Enter an SA type code in the AGMT TYPE field.
    4. Press a transmit key to advance to the ASA1 screen and begin to update the service agreement.

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