DEPARTMENT OF PUBLIC WELFARE



DEPARTMENT OF PUBLIC WELFARE

OFFICE OF Long Term Living

Bureau of Home and Community Based Services

HCSIS Implementation Guidebook

April 18, 2007

HCSIS IMPLEMENTATION GUIDEBOOK TABLE OF CONTENTS

Introduction to the HCSIS Implementation Guidebook 3

1.0 HCSIS Functionalities 3

2.0 Preparing for Implementation 3

3.0 Explanation of Claims Processing 3

Appendix A: Glossary 3

Appendix B: Help Desk FAQ 3

Appendix C: PROMISe HCSIS Tip Sheet 3

Appendix D: Web Browser Settings and Encryption 3

Appendix E: Troubleshooting Slow Access to HCSIS Site 3

Introduction to the HCSIS Implementation Guidebook

HCSIS Overview and Reasons for Implementation

In order to improve the management of Pennsylvania’s home and community based services, the Pennsylvania Department of Public Welfare has built an information system called HCSIS (Home and Community Based Services Information System). DPW and its partners use HCSIS to automate the collection, storage, analysis and retrieval of information for its home and community based waivers and programs.

Currently, the Office of Long Term Living (OLTL) uses HCSIS to maintain consumer records centrally. With the full implementation of HCSIS, Service Coordination Providers will be the primary users of HCSIS. Through the training and implementation activities discussed in this guidebook, OLTL plans to enable Service Coordinators (SCs) and other staff to access and use HCSIS directly. HCSIS will also be used by Administrative Entities to aid in consumer enrollment, service approval, monitoring, and reporting duties.

Additionally, since March 1, 2004, HCSIS has been used in provider claim processing. When a provider submits a claim to PROMISe (DPW’s Medicaid Management System) the claim is verified in HCSIS. By giving SC Providers direct access to HCSIS, they will be able to increase claims processing accuracy.

How to Use this Guidebook

The implementation guidebook is a tool specifically designed to prepare Service Coordination Providers for the use of HCSIS and the new activities associated with the system.

The icons below are used throughout the guidebook to help you identify key pieces of information. The meaning of each icon is also displayed below:

|[pic] |Important concept to remember as you implement and use HCSIS |

| |Best practice or recommendation for improving your use of HCSIS |

|[pic] | |

| |Resources for assistance or more information |

|[pic] | |

Summary of HCSIS Implementation Guidebook Contents

The table below provides a summary of the contents for each of the guidebook sections.

| | |

|Section |Contents |

|Section 1.0: HCSIS Functionalities |Section 1.0 provides a high level overview of the benefits HCSIS offers to SCs, consumers and the |

| |DPW. After reading this section, users should understand why HCSIS is valuable and how the system|

| |can be used to streamline the enrollment and service planning processes. |

|Section 2.0: Preparing for |Section 2.0 provides detailed information about the activities that individuals in your |

|Implementation |organization will need to carry out in order to support a successful implementation of HCSIS. |

| |Each Service Coordination Provider must designate two key individuals to assist in the |

| |implementation of HCSIS: |

| | |

| |The Business Partner Administrator is responsible for the technical aspects of HCSIS in your |

| |organization. This individual will be responsible for verifying individual computers are |

| |configured to use HCSIS, creating user IDs and passwords, and conducting other technology-related |

| |activities. |

| | |

| |The Implementation Liaison will serve as the primary contact person between the Office of Long |

| |Term Living and your organization regarding the HCSIS implementation. This person will be |

| |responsible for ensuring that employees receive the necessary training materials needed to use |

| |HCSIS. |

|Section 3.0: Explanation of Claims |Section 3.0 discusses the steps involved in claims processing. There are several systems that |

|Processing |interact with each other to process a claim. To illustrate this process, two diagrams show the |

| |entire claims processing life cycle. After reading this section, users should understand how |

| |claims are processed and how to troubleshoot claims processing problems. |

1.0 HCSIS Functionalities

Home and Community Services Information System (HCSIS) was built to accomplish a number of important objectives. When fully implemented, HCSIS will:

• Collect and maintain demographic data related to consumers and service providers

• Determine and maintain a standardized individual service plan

• Improve the provider billing process

• Maintain consumer privacy in a secure technical environment

• Maintain high quality data for reporting processes

• Serve as a centralized repository for notes specifically relating to services that consumers receive through OLTL waivers and programs

Using HCSIS Functionalities

This section provides an overview of the HCSIS functionalities. A functionality within HCSIS is a set of related actions that users of the system can perform. For example, when a consumer meets with a Service Coordination Provider to select services to receive for the coming year, the provider will use HCSIS functionality called “Individual Service Plan.” The following functionalities will be available to OLTL Service Coordination Providers:

• Register for Services

• Service Coordination

• Individual Service Plan (ISP)

• Create and Receive Alerts

• Claims Processing

• Service Notes

| | |

|HCSIS Functionality |Description |

|Register for Services |The Register for Services functionality is the beginning point for consumers seeking home and |

| |community based services in the Commonwealth of Pennsylvania. Upon contacting a Service |

| |Coordination Provider, the consumer record will be entered into HCSIS. Once this process is |

| |initiated, the SC can use HCSIS to track and submit eligibility documentation and collect |

| |demographic information. |

|Service Coordination |HCSIS is designed to streamline the daily activities of Service Coordinators, SC Supervision Staff|

| |and State Program Office Staff. The SC uses HCSIS to develop an individual plan and locate and |

| |coordinate services. Using HCSIS, SCs are able to access information about the consumer, track |

| |interactions with the consumer and capture service notes. Additionally, SC Supervisors, Program |

| |Managers, and Administrative Entity staff will use HCSIS to facilitate the transfer of consumer |

| |records. |

|Individual Service Plan (ISP) |The SC will facilitate the collection of the required plan information from the consumer, and if |

| |appropriate, the consumer’s family. The information is entered into HCSIS and used to develop a |

| |draft plan. Based on the gathered information, the consumer’s SC works with the consumer to |

| |establish a set of desired services. When all of the services are identified, the consumer and SC |

| |may begin the process of identifying and selecting qualified providers to be funded by the HCBS |

| |waiver or program. HCSIS stores ISP information, so that when future ISPs are developed for a |

| |consumer, only the modified information will need to be re-entered. |

|Create and Receive Alerts |Alert functionality has been designed and built into the system to assist Service Coordination |

| |Provider staff in completing business activities. An alert is an electronic message triggered from|

| |an action in HCSIS to inform a user of an event that occurred, or did not occur, as expected |

| |within the system. For example, an alert may inform a SC that a new consumer has been added to |

| |his/her caseload. Alerts may be used for informational, reminder or escalation purposes. |

|Claims Processing |Claims processing functionality makes it possible for providers to be paid for services through |

| |the Provider Reimbursement Operations Information System (PROMISe). See section 3.0 of this |

| |guidebook for more information on how PROMISe and HCSIS interact. |

|Service Notes |Service notes document meetings and other contacts with consumers, their family, or service staff.|

| |SCs have the ability to create service notes, while SC supervisors have the ability to review and |

| |edit them. |

|[pic] |HCSIS is used by other Departments in the Commonwealth and other DPW program offices. Different offices use different |

| |functionalities in HCSIS. When you try to navigate to a part of HCSIS that is not in use by OLTL, you will see a |

| |message at the top of the page that says “You have no access rights for this page.” |

2.0 Preparing for Implementation

A number of tasks need to be accomplished to prepare Service Coordination Providers for a successful implementation of HCSIS. To facilitate this work, the OLTL HCSIS Implementation Team will offer Service Coordination Providers support through training materials and the HCSIS Help Desk. Another form of support are tools such as this guidebook. Sections 2.1 and 2.2 of this guidebook provide detailed information regarding the tasks to be completed by each organization’s HCSIS Business Partner Administrator and Implementation Liaison.

The key responsibilities of these individuals are listed below:

▪ The Business Partner Administrator is responsible for the technical aspects of HCSIS in your organization. This individual will be responsible for verifying that individual computers are configured to use HCSIS, creating user IDs and passwords, and conducting other technology-related activities.

▪ The Implementation Liaison will serve as the primary contact person between the Office of Long Term Living and your organization regarding the use of HCSIS. This person will be responsible for ensuring that employees receive the necessary training materials needed to use HCSIS.

2.1 HCSIS Business Partner Administrator Implementation Checklist

As Business Partner Administrator, you are responsible for the technical aspects of HCSIS in your organization. This includes verifying that individual computers are configured to use HCSIS, creating user IDs and passwords, and conducting other technology-related activities. The list of tasks you are responsible for over the course of the implementation effort are summarized below and detailed in the following tables.

| | |

|Task Number |Business Partner Administrator Task Description |

|[pic] |Task # 1 | |

| | |Verify staff members who will be using HCSIS have personal computers, printers and |

| | |Internet/network access |

|[pic] |Task # 2 |Check browser settings for personal computers used to access the Internet |

|[pic] |Task # 3 |Complete a Department of Public Welfare User Agreement and fax it the HCSIS Help Desk |

|[pic] |Task # 4 |Work with your organization’s Implementation Liaison to identify roles needed for all staff that |

| | |will be using HCSIS |

|[pic] |Task # 5 |Create LMS user IDs, passwords, and user profiles for your organization’s users |

|[pic] |Task # 6 |Create HCSIS User IDs, passwords, and user profiles |

|[pic] |Task # 7 |Distribute HCSIS user IDs and passwords to new HCSIS users and confirm all users have received |

| | |HCSIS password guidelines |

|[pic] |Task #1 |What to Do… |

|1. Verify staff members who will be using|Check to make sure that all hardware meets technical requirements for HCSIS |

|HCSIS have personal computers, printers |To facilitate access to HCSIS, specific technical requirements have been established, including |

|and Internet/network access |guidelines on the necessary hardware and software and the appropriate level of computer and |

| |Internet access. The minimum standards prescribed in the chart below will allow Service |

| |Coordination Providers to use HCSIS; however, organizations who meet the optimal standards will |

| |greatly minimize the users’ time and effort to navigate HCSIS. Service Coordination Providers that|

| |do not have computers or whose computers do not currently meet these standards will need to invest|

| |in the appropriate hardware and software. |

| |[pic] |Previous HCSIS implementations have shown that: |

| | |Organizations using hardware and software that meets the optimal configuration and |

| | |connectivity specifications are able to complete HCSIS tasks faster and have fewer |

| | |problems. |

| | |Organizations using Microsoft Office 2000 or above have fewer problems accessing |

| | |Word, Excel, Access, and PowerPoint attachments to e-mails sent by DPW. |

|Category |Component |Minimum Configuration Requirements | |

| | | |Optimal Configuration Requirements |

|Hardware |Processor |Pentium II or equivalent processor (400 MHz|Pentium III or equivalent processor (450 MHz or |

| | |or higher) |higher) |

| |RAM |128 MB |128 MB |

| |Hard Drive |4.0 GB |6.0 GB |

| |CD Rom Drive |10X |10X |

| |Printer |Access to a network or local printer |Access to a network or local printer |

|Software |Operating System |Windows 95 or later |Windows 2000, NT, ME or XP |

|Settings |Screen Resolution |800 x 600 pixels |1024 x 768 pixels or higher |

|Access |Computer |All users must have access to a fully |All users must have access to a fully configured |

| | |configured computer |computer |

| |Internet |All computers must have an Internet |High Speed Line (T, DSL or Cable Modem), High Speed|

| | |connection of 128 kbps or faster |Modem (128 kbps or faster) |

| |Web Browser |Web browser with 128-bit encryption |Internet Explorer 5.0 or higher with 128 bit |

| | | |encryption |

|[pic] |Task #2 |What to Do… |

|2. Check browser settings for personal |Confirm that all personal computers can access HCSIS |

|computers (PCs) used to access the |Because many organizations have firewall settings in place which may need to be upgraded prior to |

|Internet |HCSIS implementation, it is imperative to check that all users’ computers can access HCSIS. |

| |[pic] |Instructions for how to confirm that personal computers can access HCSIS are listed |

| | |in Appendix D, Web Browser Settings and Encryption. |

| |Check to make sure browser encryption options are activated |

| |Even with the HCSIS security system in place, users must share in the responsibility of keeping |

| |information secure. Encryption enables the secure exchange of information over the Internet. |

| |Before any information is transmitted to HCSIS, it is transformed into an unrecognizable string of|

| |characters, ensuring that the privacy of the information is maintained as it is transmitted over |

| |the Internet. The information is then decoded back to meaningful information upon receipt by |

| |HCSIS. Instructions for checking if your browser has 128 bit encryption (and upgrading the |

| |browser if it does not) are listed in Appendix D, Web Browser Settings and Encryption. |

| |[pic] |HCSIS includes additional security measures |

| | |to minimize the security risks associated with unauthorized users accessing sensitive|

| | |case information: |

| | |Firewalls (or barriers) deter unauthorized access to the server where HCSIS resides |

| | |User names and passwords assigned to every user of HCSIS allow for application level |

| | |security so that users will only be permitted to access and change information that |

| | |they need to do their jobs |

| | |An “audit trail” will track the date of when information was changed, and the user |

| | |who changed the data |

| |Troubleshoot Problems with Slow HCSIS Site |

| |The performance of HCSIS is dependent on a number of factors, such as Service Coordination |

| |Provider Internet connection speed, capacity of the HCSIS server, and activity of other |

| |applications residing on the HCSIS server. Due to these reasons, occasionally the application may |

| |perform at below normal response times. |

| |[pic] |Instructions on how to troubleshoot and correct slow access to the HCSIS site are |

| | |listed in Appendix E, Troubleshooting Slow HCSIS Site. |

|[pic] |Task #3 |What to Do… |

|3. Complete a Department of Public |Fill out Department of Public Welfare User Agreement Form |

|Welfare User Agreement and fax it the |To have the HCSIS Help Desk create a user ID and password for you, fax a completed Department of |

|HCSIS Help Desk |Public Welfare User Agreement to the HCSIS Help Desk at (717) 540-0960. On the form, be sure to |

| |identify yourself as the “Local Business Partner Administrator for [Insert Name of Your |

| |Organization]”. This form may be accessed on-line at |

| |. |

|[pic] |Task #4 |What to Do… |

|4. Work with your organization’s |Assist the Implementation Liaison in assigning roles to HCSIS users in your organization. |

|Implementation Liaison to identify roles |Role mapping is the process of determining “who” should do “what” in HCSIS. Based on the job |

|needed for all staff that will be using |function of a particular person at your organization, you will need to determine what role that |

|HCSIS |person should be assigned in HCSIS. Role mapping is the responsibility of your organization’s |

| |Implementation Liaison. However, it is important for you to assist the Implementation Liaison in |

| |the activity of role mapping, since you will be responsible for using the results of the role |

| |mapping to assign roles to HCSIS users. |

| |[pic] |The OLTL HCSIS Implementation Team has created a role mapping tool kit, which |

| | |includes instructions, a list of available roles in HCSIS, and worksheet to record |

| | |which roles should be assigned to your organization’s users. If you have not |

| | |received these materials and you need to begin role mapping, please contact a member|

| | |of the OLTL HCSIS Implementation Team. |

|[pic] |Task #5 |What to Do… |

|5. Create LMS user IDs, passwords, and |[pic] |The Learning Management System (LMS) is a web-based application used to assist with |

|user profiles for your organization’s | |training logistical tasks including scheduling, registration, communication of |

|users | |course information, and delivery of training. It is not part of HCSIS, but is used |

| | |to administer the HCSIS training program. |

| |Download the LMS Registrar Job Aid from the LMS |

| |As the HCSIS Business Partner Administrator for your organization, you are also the Learning |

| |Management System (LMS) Registrar for your organization. As the LMS Registrar, you have the |

| |ability to create users IDs, passwords, and user profiles for individuals in your organization who|

| |need access to the LMS. Every person who will be a HCSIS user will also need access to the LMS. |

| |You can download the LMS Registrar Job Aid from the HCSIS Learning Management System at |

| |. |

| |[pic] |The Registrar Job Aid will explain step-by-step how to create LMS user IDs, |

| | |passwords, and user profiles for the users in your organization. |

| |Create LMS user IDs, passwords, and user profiles for your organization’s LMS/HCSIS users. |

| |Once role mapping is completed you will use the role mapping spreadsheet in conjunction with the |

| |Registrar Job Aid located on the LMS to create LMS profiles for your organizations users. Role |

| |mapping must be completed before you can create LMS user profiles because the training made |

| |available to individuals through the LMS is role-based. In other words, the HCSIS role assigned |

| |to a user in the LMS will determine which training materials are made available when the user logs|

| |on to the LMS. |

|[pic] |Task #6 |What to Do… |

|6. Create HCSIS User IDs, passwords, and |Obtain the Business Partner Administration Job Aid from the LMS |

|user profiles. |The HCSIS Business Partner Administration Job Aid explains the various tasks that each HCSIS |

| |Business Partner Administrator is asked to perform in HCSIS. It can be obtained on the HCSIS |

| |Learning Management System (LMS) at . You should |

| |read this document and contact the Help Desk with questions so that you are prepared to perform |

| |Business Partner Administrator tasks in HCSIS. |

| |[pic] |The HCSIS Business Partner Administration Job Aid will explain step-by-step how to |

| | |create HCSIS user IDs, passwords, and user profiles for the users in your |

| | |organization. |

| |Require HCSIS users to complete DPW User and Agreement |

| |Every HCSIS user must sign the Department of Public Welfare User Agreement before you can create |

| |the individual’s user ID, password, and profile. Send users a copy of the form or the link to the|

| |form on the web, have them complete it, and return to you. You can then fax the agreements to the|

| |HCSIS Help Desk at (717) 540-0960. |

| | |

| |The form can be found on-line at: |

| | |

| |Create HCSIS user IDs, passwords, and user profiles for your organization’s HCSIS users |

| |Use the completed role mapping spreadsheet in conjunction with the HCSIS Business Partner |

| |Administration Job Aid to create HCSIS user IDs, passwords, and profiles for your organizations |

| |users. |

| |[pic] |The Difference between LMS and HCSIS |

| | |Creating LMS user IDs, passwords, and user profiles enables users to access training|

| | |materials and take web-based courses. Creating HCSIS user IDs, passwords, and user |

| | |profiles enables users to access HCSIS. They are two separate systems and require |

| | |different user IDs and passwords. |

|[pic] |Task #7 |What to Do… |

|7. Distribute HCSIS user IDs and |Distribute User ID’s via Email or Other Specified Method |

|passwords to new HCSIS users and verify |Once HCSIS user IDs and passwords have been created they need to be distributed to users. HCSIS |

|all users have received HCSIS password |password guidelines should be included with HCSIS user IDs and passwords distributed to each user.|

|guidelines. |You should also inform users that after they log into HCSIS for the first time, they will have to |

| |change their password. |

| |[pic] |The HCSIS password requirements are: |

| | |Passwords must be between 7 and 14 characters in length |

| | |Passwords must contain 3 of the following 4 items: |

| | |A number (e.g. 3) |

| | |An uppercase letter (e.g. H) |

| | |A special character (e.g. #) |

| | |A lowercase letter (e.g. h) |

| | |Passwords cannot contain the space character, cannot be your name or the name of |

| | |your agency, and cannot be a password you used in the past |

Ongoing Responsibilities

As the HCSIS Business Partner Administrator for your organization you will have several ongoing responsibilities once HCSIS is implemented.  They include:

 

• Creating new HCSIS and LMS user accounts as new staff members join your organization.

• Deactivating HCSIS user accounts of staff members who leave your organization.

• Resetting HCSIS passwords for staff members who inadvertently lock themselves out of the system or forget their password.  Remember the HCSIS Help Desk will only reset user’s passwords for your organization’s staff members in an emergency!  

• Serving as first level support for all HCSIS technical questions which arise with your organization’s HCSIS users.   

2.2 HCSIS Implementation Liaison Implementation Checklist

Adequate preparation will be essential to the success of HCSIS. The following section provides more detailed instruction about the activities that need to be completed by the Implementation Liaison in order to prepare your organization for the use of HCSIS.

As the Implementation Liaison, you serve as the primary contact person between the Office of Long Term Living and your organization regarding the HCSIS implementation. You are responsible for soliciting questions and issues from users regarding HCSIS and confirming that your organization has completed the necessary steps for a successful implementation. The list of tasks you are responsible for over the course of the implementation effort are summarized below and detailed in the following tables.

| | |

|Task Number |Implementation Liaison Task Description |

|[pic] |Task # 1 | |

| | |Determine who in your organization will need HCSIS training |

|[pic] |Task # 2 |Work with the Business Partner Administrator to complete role mapping |

|[pic] |Task # 3 |Work with the Business Partner Administrator to verify users have been assigned roles and training|

| | |profiles in LMS |

|[pic] |Task # 4 |Verify HCSIS users have basic PC, Windows and e-mail skills |

|[pic] |Task # 5 |Confirm HCSIS users have completed the web-based classes |

|[pic] |Task # 6 |Establish process to gather user questions and issues |

|[pic] |Task #1 |What to Do… |

|1. Determine who in your organization |Inform individuals of available HCSIS training |

|will need HCSIS training |Contact individuals in your organization who require training and ask them to complete HCSIS |

| |Job-aids and Web-based training. |

| |[pic] |HCSIS training will be delivered through a variety of methods depending on the |

| | |complexity of course material and user population size. These methods include: |

| | |job-aids and web-based training (WBT). |

| | |Job-aids are documents designed to describe a business process in step-by-step |

| | |detail, similar to a users’ actual work environment. |

| | |Web-based training is accessed over the Internet on a computer without an instructor|

| | |present. |

| |Inform users that they can download the LMS User Job Aid |

| |The LMS User Job Aid explains how to navigate the LMS. Directions for accessing the LMS User Job |

| |Aid are below: |

| |Go to the website: hcsis.state.pa.us |

| |Click on “Learning Management System” |

| |Log on to the LMS |

| |Click on “LMS Support” at the bottom left corner of the |

| |page |

| |Click on “LMS User Job Aid” |

| |[pic] |The goals of HCSIS training are to: |

| | |Prepare HCSIS users to perform assigned duties in the system |

| | |Inform end users about the purpose and capabilities of the HCSIS application |

| | |Provide Service Coordination Provider staff with practice and experience using HCSIS|

| | |before its implementation |

| | |Provide the foundation for acceptance of the application |

|Job Function |Recommended Web-based Training |

|Service coordination, intake, enrollment |HCSIS Navigation (I hr) |

| |Register for Services (4 hrs) |

|Supervision of SCs, caseload management |HCSIS Navigation (I hr) |

| |Register for Services (4 hrs) |

|Fiscal Management |HCSIS Navigation (I hr) |

|Claims Processing |HCSIS Navigation (I hr) |

| |Register for Services (4 hrs) |

|Executive/Management |HCSIS Navigation (I hr) |

|[pic] |Task #2 |What to Do… |

|2. Work with the Business Partner |Assign roles to HCSIS users in your organization. |

|Administrator to complete role mapping |Role mapping is the process of determining “who” should do “what” in HCSIS. Based on the job |

| |function of a particular person at your organization, you will need to determine what role that |

| |person should be assigned in HCSIS. As the Implementation Liaison, it is your responsibility to |

| |conduct role mapping. However, you should work closely with the Business Partner Administrator in|

| |conducting the role mapping, because the Business Partner Administrator will use the output of the|

| |role mapping activity to create user profiles in HCSIS. |

| |[pic] |The OLTL HCSIS Implementation Team has created a role mapping tool kit, which |

| | |includes instructions, a list of available roles in HCSIS, and worksheet to record |

| | |which roles should be assigned to your organization’s users. If you have not |

| | |received these materials and you need to begin role mapping, please contact a member|

| | |of the OLTL HCSIS Implementation Team. |

|[pic] |Task #3 |What to Do… |

|3. Work with Business Partner |Work with Business Partner Administrator to verify users have been assigned roles and training |

|Administrator to verify users have been |profiles in LMS |

|assigned roles in LMS |You should work with the Business Partner Administrator to verify this task is completed so that |

| |users have sufficient time to take the web-based courses. Most of these tasks will be completed |

| |using the Learning Management System (LMS). The Business Partner Administrator will establish user|

| |IDs and passwords for each of your organization’s HCSIS users in the LMS and use the LMS to |

| |generate an email to each user informing the user of the location of the LMS site. Each user will|

| |have access to personalized training resources through the LMS. |

| |[pic] |The Learning Management System (LMS) is a web-based application used to distribute |

| | |training materials and HCSIS information. The LMS will be used to assist in the |

| | |management of the following: |

| | |Access to material, including job-aids |

| | |Deployment of web-based courseware |

| |[pic] |The Difference between LMS and HCSIS |

| | |Creating LMS user IDs, passwords, and user profiles enables users to take web-based |

| | |courses. Creating HCSIS user IDs, passwords, and user profiles enables users to |

| | |access HCSIS. They are two separate systems and require different user IDs and |

| | |passwords. |

|[pic] |Task #4 |What to Do… |

|4. Verify HCSIS users have basic PC, |Assess Users’ Skills in Basic Windows Functionality |

|Windows and e-mail skills |Before training can take place, it is necessary that all staff members have acquired the necessary|

| |computer skills. To participate in training and use HCSIS, all users must know how to do the |

| |following: |

| |Navigate and operate Microsoft Windows |

| |Use word processing (SUCH AS Microsoft Word) |

| |Navigate the Internet |

| |Use the mouse and keyboard to navigate the screen |

| |Start and exit Microsoft Windows, explore desktop, and use program menus |

| |Open, close, minimize and re-size windows |

| |Use a web browser, such as Internet Explorer |

| |Perform basic editing, including cut, copy and paste |

| |Use Windows help facilities |

| |Print documents |

| | |

| |Service Coordination Provider staff members who do not currently have these skills will need to |

| |complete internal training to develop them. |

|[pic] |Task #5 |What to Do… |

|5. Confirm HCSIS users have completed the|Ask users to confirm that they have completed web-based courses |

|web-based classes |Verify that individuals in your organization have completed the required web-based courses by |

| |asking them to confirm with you that they have successfully completed the courses. |

| |[pic] |Completion of the web-based courses is very important for ensuring the successful |

| | |use of HCSIS. |

|[pic] |Task #6 |What to Do… |

|6. Establish process to gather user |Address procedural and policy questions |

|questions and issues |An important part of your role as implementation liaison is to solicit user questions, concerns, |

| |and issues regarding the use of HCSIS. Users will be able to contact the HCSIS Help Desk with |

| |questions, but there will likely be policy or procedural questions that you will need to gather |

| |and ask OLTL to address. |

| |[pic] |For the first few weeks after you begin using HCSIS, consider using part of a weekly|

| | |staff meeting to gather user questions and issues regarding HCSIS. |

3.0 Explanation of Claims Processing

In March 2004, providers offering services under the Medicaid waivers managed by the Office of Long Term Living (OLTL) began submitting claims (bills) for payment via PROMISe. PROMISe is the new HIPAA-compliant claims processing and management information system implemented by DPW in March 2004, replacing MAMIS (Medical Assistance Management Information System). In order to ensure your organization is paid promptly and accurately, it is important that everyone who uses HCSIS understand how HCSIS and PROMISe work together to process a claim.

3.1 The PROMISe/CIS/HCSIS Relationship

The PROMISe/CIS/HCSIS Relationship diagram, above, depicts the relationship PROMISe has with two other systems, Client Information System (CIS) and the Home and Community Services Information System (HCSIS). CIS is the system that houses all information related to individuals’ eligibility, such as waiver, Health Care Benefits Packages, etc. HCSIS is the system that houses individuals’ services and supports information including service plan data and related service information. It is crucial for all information housed in each of the three systems to be correct in order for an OLTL waiver claim to process correctly, as the information on the claim is verified with all three systems.

In the following diagram, “GOOD Provider” submits a claim for 10 units of Attendant Care provided on 4/13/07. The claim first goes to PROMISe where PROMISe uses the Provider Eligibility Program (PEP) to verify that the provider is enrolled to bill for the Attendant Care waiver. Next the claim moves to CIS to verify that the individual is eligible for the Attendant Care waiver. From CIS the claim goes back to PROMISe and then PROMISe sends the claim to HCSIS. HCSIS checks the ISP – Individual Service Plan – to confirm that “GOOD Provider” was authorized to provide 10 units of Attendant Care on 4/13/07. If that information is on the consumer’s ISP then the claim is approved (No Error) in HCSIS and returned to PROMISe. PROMISe does a final verification and then pays the claim. If the claim is not approved in HCSIS (Error) the claim is rejected by HCSIS and sent to PROMISe where PROMISe suspends or rejects the claim and assigns an error code to explain why the claim was suspended or rejected.

Life of a Waiver Claim

The diagram below, and the explanation that follows, provides more detail about how a claim is processed via PROMISe and CIS before it is sent to HCSIS for processing.

[pic]

[pic] PROMISe obtains eligibility information from CIS using the individual’s Medical Assistance

(MA ID) number and verifies that the individual is eligible to receive the service on the claim.

[pic]PROMISe verifies that the provider is enrolled to provide the service(s).

[pic]After the validation steps above occur, the claim information is sent to HCSIS to be validated

against the individual’s ISP and eligibility information in HCSIS.

The PROMISe claim information is sent to HCSIS to be validated against the individual’s ISP. The following represents information entered on the Service Details and Waiver/Program Enrollment screens in HCSIS:

• Individual – verified by the individual’s Medical Assistance number (MA#) on the PROMISe claim.

• Provider – verified by the provider’s Master Provider Index (MPI) number on the PROMISe claim.

• Site – verified to be equivalent to the service location code on the PROMISe claim. HCSIS does not currently verify site information for OLTL claims.

• Service – verified by the procedure code on the claim. HCSIS lists services by service name and PROMISe lists services by procedure code. HCSIS matches every procedure code from the claim to the appropriate service name in HCSIS.

• Units – verified to be equal to or greater than the units on the claim.

• Rate – verified to be equal to the per unit rate used to calculate the service cost on the claim. Please note: HCSIS displays the service’s rate as a rate per unit on the individual’s service details and PROMISe displays the service’s rate on a claim as the total service cost (rate per unit x service rate).

• Service Start Date – verified to be on or before the service date on the claim.

• Service End Date – verified to be on or after the service date on the claim.

• Waiver/Program Enrollment – verified to be the same as the eligibility that was found in CIS.

If any of the information on the PROMISe claim is in conflict with the individual’s ISP or waiver/program enrollment information, HCSIS sends an error code to PROMISe and PROMISe suspends or denies the claim. HCSIS may return an informational code that does not suspend or deny the claim, but will indicate partial approval of the claim (rate cutback) or allowable discrepancies between the information on the claim, CIS and HCSIS. PROMISe translates the error code from HCSIS into a PROMISe error code and assigns this code to the claim. The PROMISe Error Status Codes (ESCs) that denote denials or informational errors are included on the Remittance Advice (RA) distributed to providers.

Once errors have been resolved, it may be necessary to resubmit the claim.

• If the original claim was denied, a new claim must be submitted, containing all service lines submitted on the original claim with the modifications. If it is more than 180 days from the service date, you must reference the original ICN or it will hit the 180 day exception.

.

| |Some of the data in HCSIS that is used to verify claims is updated nightly through a batch process in HCSIS. This means |

|[pic] |that some changes made in HCSIS during the day will not be available to PROMISe until the next day. As a safeguard, when |

| |HCSIS is updated to resolve a claim issue, the claim should not be submitted until the day after HCSIS is updated. |

|[pic] |For more information about resolving claims processing issues, see Appendix C, PROMISe HCSIS Tip Sheet. |

A number of appendices with detailed information regarding terms, PROMISe, and HCSIS can be found in the remainder of this guidebook. If you have any questions that are not answered in these materials, please contact a member of the HCSIS OLTL Implementation team.

Appendix A: Glossary

|Acronym |Term |Definition |

|AE |Administrative Entity |Entities which currently review consumer intake and provide case management for Home and Community Based Service Programs in |

| | |Pennsylvania. |

|ATS |Automated Tracking System |Commonwealth of Pennsylvania database system used to track Problem Change Requests (PCRs), log calls, and manage other data. |

|COMPASS |Commonwealth of Pennsylvania |Online screening questionnaire and application to receive social services through the Commonwealth of Pennsylvania. |

| |Application for Social Services | |

|CIS |Client Information System |The Department’s automated system that contains demographic and eligibility information for all Medical Assistance recipients. |

|CMS |Centers for Medicare & Medicaid |Administers the Medicare program and works in partnership with the States to administer Medicaid, the State Children’s Health Insurance |

| |Services |Program (SCHIP), and health insurance portability standards. |

|DPW |Department of Public Welfare |The Department of Public Welfare is Pennsylvania's largest state agency and one of the largest state human service agencies in the |

| | |nation. |

|HCBS |Home and Community Based Services |Services furnished to a consumer in his/ her home and community in order to prevent institutionalization. |

|HCSIS |Home and Community Based Services |HCSIS is a web enabled information system built to serve as the information system for all DPW program offices that support the Home and|

| |Information System |Community-Based Services Waivers. |

|HIPAA |Health Insurance Portability and |Passed in 1996, the act requires the development of standard transaction codes and security requirements to create a more simplified |

| |Accountability Act |environment for processing medical claims. Home and Community Based Services are included in the legislation. |

|ILT |Instructor-Led Training |Training conducted in a classroom by an instructor to an audience of students. Involves gaining hands-on experience with HCSIS. |

|ISP |Individual Support Plan |A plan developed by each consumer and their Supports Coordinator which will include services and supports, their frequency and duration.|

| | |The ISP will be the foundation of the consumer’s budget. |

|EDS |Electronic Data Systems |Vendor who manages PROMISe. |

|LAN |Local Area Network |Group of computers and associated devices (such as printers) that share a common communications line. |

|LMS |Learning Management System |The Learning Management System is a web-based too used for HCSIS training with many functions including registration, scheduling, and |

| | |reporting. |

|MA |Medical Assistance |Medical Assistance (Medicaid) is a program that pays for medical care for certain individuals and families with low incomes and |

| | |resources. |

|MCI (#) |Master Client Index Number |Unique identification number to be assigned to each consumer receiving services through the Pennsylvania Department of Public Welfare in|

| | |the future. |

|MPI |Master Provider Index |Central repository of provider profiles and demographic information that registers and identifies providers uniquely within DPW. |

|OMAP |Office of Medical Assistance Program |Responsible for the statewide administration of Pennsylvania's Medical Assistance Program that purchases medical and health care |

| | |services on behalf of Medical Assistance recipients in an efficient, economical and accountable manner. |

|OLTL |Office of Long Term Living |One of several program offices within the Department of Public Welfare. The OLTL is comprised of the Deputy's Office, the Bureau of Home|

| | |and Community Based Services, the Bureau of Supportive Social Services, the Bureau of Program Management, and Personal Care Home |

| | |Licensing. |

|PCR |Problem Change Request | Format for submitting a request to change the HCSIS application. |

|PDA |Department of Aging |pda.state.pa.us |

|PROMISe |Provider Reimbursement Operations |PROMISe is the new HIPAA-compliant claims processing and management information system implemented by DPW in March 2004, replacing MAMIS|

| |Management Information System |(Medical Assistance Management Information System). The objectives of PROMISe include: |

| | |HIPAA compliance |

| | |Comprehensive support for managed care |

| | |Payment of all fee for service claims |

| | |Payment of waiver services for OLTL, ODP, OMAP, and OMHSAS |

| | |Payment of other non-Medicaid health care claims |

| | |Web enabled functionality to support provider interface |

| | |On-line adjudication for all claim types |

|RAM |Random Access Memory |Short-term data storage and processing capacity in a PC. |

|SAT |System Acceptance Testing |End-user testing of the new system prior to the system release. |

|SC |Service or Supports Coordinator |Person who helps plan, locate, coordinate and monitor supports and services for an consumer and who informs consumers of and helps |

| | |consumers exercise his/her rights. |

|SME |Subject Matter Expert |Individual with specific expertise from a policy, procedure, or program viewpoint; expertise is used for system design and support. |

|SSD |Services and Supports Directory |This directory stores information about the current services offered by providers. |

|SSN |Social Security Number |Unique government issued identifier |

|WBT |Web-Based Training |Training accessed over the Internet without an instructor present. |

Other Terms

|Acronym |Term |Definition |

| |Alternate ID |Alternate ID refers to Social Security Number (SSN), Base Service Unit (BSU) number, Master Client Index (MCI) number, Medicaid (MA) |

| | |number or Medicare number. |

| |Alert |An electronic message triggered from an action in HCSIS to inform a user of an event that occurred, or did not occur, as expected within|

| | |the system. |

| |Application Development |Designing and building custom software or modifying packaged software for a computer system; (Microsoft Word is considered a computer |

| | |‘application’). |

| |Business Process |A series of steps that result in a defined end point for a given business activity (ex: Registering a consumer) |

| |Service Notes |Notes taken during meetings and other contacts with a consumer that are recorded in the service notes portion of a consumer’s record in |

| | |HCSIS. |

| |Case Transfers |Case transfers occur when individuals are moved from one caseload to another. Examples of transfers include a transfer within the |

| | |current entity, a transfer outside the current entity but within the same Service Coordination Provider Region, and a transfer to |

| | |another Service Coordination Provider Region. |

| | | |

| |Caseload Facesheet |This page allows a user to see names of consumers assigned to their caseload as well as Master Client Index (MCI) number, Date of Birth,|

| | |ISP End Date and Primary Funding. The caseload facesheet also displays the total number of consumers in the caseload. The user can link |

| | |from this information directly to a consumer’s individual facesheet. |

| |Clearance |The clearance process is the manner by which consumers’ records are added to HCSIS. When a new consumer is introduced, the consumer’s |

| | |data must be checked against previously existing consumers across the state to prevent duplicate records existing for one consumer and |

| | |other data integrity problems. When a consumer’s record is determined to be unique, that record is added to HCSIS, or cleared. Consumers|

| | |can be cleared at three levels: |

| | |Into the Service Coordination Provider Region |

| | |Into the SC Entity |

| | |Onto the SC caseload |

| |Encryption |Encryption is the conversion of data into a code for security controls. Data sent into HCSIS through the Internet is encrypted. |

| |Functionality |A functionality within HCSIS is a set of specific related actions users of a system can perform. For example, when a consumer registers |

| | |with a Service Coordination Provider to select services, HCSIS handles the information needs through the register functionality. |

| |Go-live Date |The date for the new system to go into production given the business and end-user needs and constraints. |

| |Implementation |Planning, preparation, and deployment of the new system to the end-users. |

| |Individual Record Status |A status assigned to an consumer’s electronic record in HCSIS. A consumer’s record status can be either Active or Inactive. |

| |Intake |The process of collecting and entering demographic information about a consumer requesting services and supports in Pennsylvania. |

| |Integration |HCSIS environment used to test the functionality of HCSIS in conjunction with other applications, such as COMPASS |

| |(Integration Environment) | |

| |Job Aid |Job-aids are documents designed to describe a business process in step-by-step detail, similar to a users’ guide. |

| |Notice |A notice is a message generated through HCSIS containing standard text to provide consistent messages to consumers, families or |

| | |providers. |

| |Primary Contact |The name of an associate provided by the consumer identified as the first person contacted regarding the consumer’s case. |

| |Production |A system is considered ‘in production’ when it is fully functional and ready to be used by end-users. Production is also known as |

| |(Production Environment) |‘live’. |

| |Referral Screen |The referral screen in HCSIS is used to generate a referral alert to other users based on specific events, such as a new consumer |

| | |completing the Service Coordination Provider intake process. |

| |Regression |HCSIS testing to determine whether new system changes and additions have affected previous functionality. |

| |(Regression Testing) | |

| |Role Mapping |Process of matching an individual’s job duties to the individuals access level in HCSIS. |

| |Roll-out |Deployment of the new system to the end-users; see go-live. |

| |SC Entity Profile |The entity profile contains information retained in HCSIS which is used to establish access and privileges, and facilitate functionality|

| | |such as transferring individuals. |

| |Server |A computer or device on a network that manages network resources. For example, a file server is a computer and storage device dedicated |

| | |to storing files. Any user on the network can store files on the server. A print server is a computer that manages one or more printers,|

| | |and a network server is a computer that manages network traffic. A database server is a computer system that processes database queries.|

| | |Servers are often dedicated, meaning that they perform no other tasks besides their server tasks. |

| |Site preparation |Preparation of the end-user computing and operational environments prior to the release of the new system. |

| |Supports/Service Coordinator (SC) |The SC profile contains each Supports Service Coordinator’s name and is used to establish access and privileges within HCSIS. The |

| |Profile |profile may be used by SC Supervisors to oversee Supports Service Coordinator training, provide basic information about each Supports |

| | |Service Coordinator, and help assign individuals to Supports Service Coordinators. |

| |Testing |Series of steps in the development cycle of an application to check that it is fully functional before deployed to end users. |

| |Training |End-user preparation and instruction on how to use the new system. |

| |User Profile |The combination of username, password, role, scope, and user identification that allows an individual to gain access to HCSIS. |

| |Web-enabled Application (HCSIS) |A computer application which can be accessed and updated through the Internet. |

Appendix B: Help Desk FAQ

|Question |Answer |

|How do I contact the HCSIS Help Desk? |Call 1(866)444-1264 |

| |OR |

| |Email c-hhcsishd@state.pa.us |

|What is the difference between the LMS and HCSIS? |The LMS is an online system where HCSIS users can download training materials and |

| |take web based training courses. |

| |HCSIS is a web enabled information system being built to serve as the information |

| |system for all Department of Public Welfare (DPW) program offices that support the |

| |Home and Community-Based Services including Medicaid Waivers. |

|How do I get a User ID and password? What is my User |Each Service Coordination Provider has at least one local Provider HCSIS Business |

|ID and password for HCSIS? |Partner Administrator who is responsible for creating and HCSIS IDs and passwords. |

| |If you are unsure who your local HCSIS Business Partner Administrator is call the |

| |HCSIS Help Desk. |

|How do I create a User ID and password for HCSIS? |The designated HCSIS Business Partner Administrator for each organization should |

| |review the HCSIS Business Partner Administration training materials for instructions.|

| |HCSIS Business Partner Administrators are the only ones (in addition to the help |

| |desk) who can create users in HCSIS. |

|How do I access the LMS? |The LMS is available on the Internet/Intranet from the following address: |

| | |

|How do I create a User ID and password for the LMS? |The designated HCSIS Business Partner Administrator for the organization should |

| |review the Registrar Job Aid for the LMS. Otherwise, contact the HCSIS Help Desk with|

| |LMS related problems. |

| |Once the HCSIS Business Partner Administrator creates the User ID and password in |

| |LMS, the original email is automatically generated and will be emailed from |

| |SQLacct01to the user. |

|Where is the LMS Job Aid? |The LMS Job Aid is available on the Welcome page of the LMS. |

|Where can I download training materials? |Download training materials off the My Curriculum link of the LMS. |

|How do I launch Basic Navigation? |Review the LMS Job Aid, available on the Welcome page of the LMS. |

|What does a HCSIS Business Partner Administrator do? |The HCSIS Business Partner Administrator is responsible for |

| |Creating user profiles in HCSIS |

| |Blocking and Unblocking accounts |

| |Resetting passwords |

| |Assigning roles |

| |Assigning scopes |

| |Maintaining the same user IDs in the LMS |

Appendix C: PROMISe HCSIS Tip Sheet

How to use this document

This document summarizes the possible system errors (edit codes on the RA) that can occur when PROMISe claims are verified against plan information in HCSIS. It also provides a description of each error code, some instructions for when to use HCSIS to assist in researching or resolving the error, and possible scenarios that could cause the error.

There are three different methods to view PROMISe claims. Each method displays either a PROMISe or a HIPAA error code:

(1) PROMISe application displays PROMISe error codes and HIPPA error codes

(2) Internet-based PROMISe application displays PROMISe error codes

(3) PROMISe error codes will appear on a provider’s paper RA

(4) HIPPA error codes will appear on a provider’s electronic RA

This tip sheet contains the following three tables to help identify HCSIS and PROMISe error codes and their resolutions:

1. HIPAA Reason Code Descriptions

2. PROMISe Errors – Technical

3. PROMISe Error Code Table

To research and resolve the claims that are assigned error codes by HCSIS, refer to the PROMISe Error Code Table.

Instructions to use the PROMISe Error Code Table:

1. Identify the PROMISe error code for the claim in the PROMISe application.

2. Review the details of the claim in PROMISe, as necessary.

3. Locate the PROMISe error code in this document using the Error Code Table in this document. The list of errors in the table is sorted by the PROMISe error code.

4. Read the description of the PROMISe error code and take the appropriate action(s) to resolve the error.

Important Note: If an error code does NOT appear on this list, then it is an error code unrelated to the PROMISe claim verification of plan information in HCSIS. Contact the PROMISe Help Desk at 1-800-248-2152 with questions about errors triggered in other areas of the PROMISe claims processing system.

HIPAA Reason Code Descriptions

|HIPAA Adj.Reason | | | |

|Code |PROMISe Error Codes |HCSIS Error Codes |HIPAA Adjustment Reason Code Description |

|B18 |904 – Susp |E005 |Payment Denied because procedure code/modifier was invalid on the date of service on claim submission |

| |951 - Deny |E006 | |

|125 |900 – Deny |E001 |Payment adjusted due to a submission/billing error |

| |901 - Susp |E002 | |

| |903 – Susp |E011 | |

| |905 – Susp |E007 | |

| |906 - Susp |E009 | |

| |907 - Susp |E010 | |

| |908 – Susp |E017 | |

| |909 – Susp |E018 | |

| |910 - Susp |E020 | |

| |912 - Susp |E021 | |

| |913 - Susp |E024 | |

| |914 - Susp |E025 | |

| |915 – Susp |E027 | |

| |952 – Deny |E008 | |

| |953 – Deny |E010 | |

| |954 – Deny |E012 | |

| |955 – Deny |E014 | |

| |957 – Deny |E016 | |

| |959 – Deny |E022 | |

| |960 – Deny |E023 | |

| |961 – Susp |E026 | |

| |962 – Deny |E028 | |

| |964 – Deny |E030 | |

| |968 - Susp |E503 | |

|31 |902 – Susp |E003 |Claim denied as patient cannot be identified as our insured |

| |950 – Deny |E004 | |

| |956 - Deny |E015 | |

|38 |963 – Deny |E029 |Services not provided or authorized by designated providers |

|45 |958 – Deny |E019 |Charges exceed your contracted/ legislated fee arrangement |

|42 |966 - Pay |E501 |Charges exceed our fee schedule or maximum allowable amount |

| |967 - Pay |E502 | |

|TBD |969 – Pay |E504 |TBD |

| |970 – Pay |E600 | |

| |971 - Deny |E033 | |

PROMISe Errors - Technical

The following table includes possible errors that would be caused by technical system issues and all require the same resolution.

| | | | |

|PROMISe Error Code |HIPAA Error |PROMISe Error Code Description |Error Resolution |

| |Code | | |

|900 – Deny |125 |Service program does not exist | |

| | | |All of these errors are related to |

| | | |technical interface problems, and |

| | | |should be a rare occurrence. |

| | | | |

| | | |If these errors occur, call the HCSIS |

| | | |Help Desk at 1-866-444-1264 to report |

| | | |the error. |

| | | | |

| | | | |

|901 – Susp |125 |Service program missing in HCSIS transaction | |

|902 – Susp |31 |Recipient ID (MCI number) missing in HCSIS transaction | |

|903 – Susp |125 |Provider ID missing in HCSIS transaction | |

|904 – Susp |B18 |Procedure missing in HCSIS transaction | |

|905 – Susp |125 |Begin Date for Service missing in HCSIS transaction | |

|906 – Susp |125 |End Date for Service missing in HCSIS transaction | |

|907 – Susp |125 |Provider’s Service Location missing in HCSIS transaction | |

|908 – Susp |125 |Units missing in HCSIS transaction | |

|909 – Susp |125 |Amount Billed missing in HCSIS transaction | |

|910 – Susp |125 |Internal Control Number (PROMISe claim) missing in HCSIS trans. | |

|912 – Susp |125 |Internal Control Nmbr (PROMISe claim) line number missing in HCSIS transaction | |

|913 – Susp |125 |Invalid transaction indicator | |

|914 – Susp |125 |Missing in HCSIS transaction | |

|915 – Susp |125 |Missing in HCSIS transaction | |

| | |PROMISe Error Code Table | |

| | | |

|PROMISe |HIPAA Error |PROMISe Error Code Description |

|Error |Code |Steps to research error in HCSIS |

|Code | | |

| | | |

|950 |31 |Recipient ID (MCI number) invalid in HCSIS. |

| | | |

|Deny | |This error occurs when the consumer whose MAID# is on the PROMISe claim: |

| | |Does not have any information in HCSIS, OR |

| | |Does not have a plan in HCSIS |

| | | |

| | |Possible Scenarios Include: |

| | |The provider is using an incorrect MCI# on the claim. |

| | |The consumer has never been entered into HCSIS. |

| | |The consumer does not have an approved plan in HCSIS. |

| | | |

| | |Follow menu path Individual > Demographics > Alt ID. |

| | |Search for the appropriate consumer in HCSIS by MCI number. If the consumer is not found, add the consumer’s information into HCSIS via menu path Individual > |

| | |Clearance > New. Then follow the program office’s guidelines to create and approve a plan for the consumer so the claim can process. |

| | | |

| | |If consumer is found then: |

| | | |

| | |Follow menu path ISP > Serv & Supp > Svc Dtls. |

| | |Search for the consumer's plan by MCI number. |

| | |Confirm that there is not a plan in HCSIS. To create a plan for the consumer, refer to SC tip sheet 4.0 Inactive Consumer. Then follow the program office’s |

| | |guidelines to approve the plan for the consumer so the claim can process. |

| | | |

|951 |B18 |Procedure (service) invalid in HCSIS. |

| | | |

|Deny | |This error occurs when the Procedure Code (Service) that is on the PROMISe claim: |

| | |Is not listed for the Provider that submitted the claim |

| | | |

| | |Possible Scenarios Include: |

| | |The Provider is using an incorrect procedure code or modifier on the claim. |

| | |The service selected on the HCSIS plan is incorrect. |

| | |The information for the service being billed was never added to the plan. |

| | | |

| | |Remember: |

| | |Some HCSIS services can be billed with more than one procedure code based on a modifier. For example, Daily Living for Agency vs. CSLA. The same Procedure Code |

| | |for the services must be on both the claim and the plan for the claim to process successfully. |

| | | |

| | |Follow menu path ISP > Serv & Supp > Svc Dtls. |

| | |Search for the consumer's plan by MCI number. |

| | |The program office and providers have mappings to examine the services on the plan compared to the claimed service (procedure code). |

| | |Remember to look for variations of the claimed service being rendered by the provider submitting the claim. |

| | |If you need to change the services on the plan, refer to SC tip sheet 3.0 Service Changes in the Supports Coordination course to perform and submit a Critical |

| | |Revision to the plan. |

| | |The day after the critical revision is approved in HCSIS, resubmit the PROMISe claim so it will verify against the new Begin Date of Service on the consumer’s |

| | |plan. |

| | | |

| | |Note: If the plan has the correct providers and services, contact the PROMISe Help Desk. |

| | | |

|952 |125 |Begin Date of Service invalid in HCSIS. This error occurs when the begin date of service entered on the PROMISe claim is before the begin date of service on the|

|(start date) |(start date) |consumer’s plan in HCSIS. |

| | | |

|Deny | |Possible Scenarios Include: |

| | |The Provider is using an incorrect procedure code or modifier on the claim. |

| | |The service selected on the HCSIS plan is incorrect. |

| | |The information for service being billed was never added to the plan. |

| | | |

| | |Follow menu path ISP > Services and Supports > Svc Dtls to verify the start date of the service on the Service Details screen. |

| | |If you need to change the service dates or add the service to the plan in HCSIS, SC tip sheet 3.0 Service Changes in the Supports Coordination course to perform|

| | |and submit a Critical Revision to the plan. |

| | |The day after the critical revision is approved in HCSIS, resubmit the PROMISe claim so it will verify against the new Begin Date of Service on the consumer’s |

| | |plan. |

| | | |

|953 |125 |End Date of Service invalid in HCSIS. This error occurs when the end date of service entered on the PROMISe claim is after the end date of service on the |

|(end date) |(end date) |consumer’s plan in HCSIS. |

| | | |

|Deny | |Possible Scenarios Include: |

| | |The Provider is using an incorrect procedure code or modifier on the claim. |

| | |The service selected on the HCSIS plan is incorrect. |

| | |The information for service being billed was never added to the plan. |

| | | |

| | |To resolve this error, refer to the instructions for PROMISe Error Code 952 (Begin Date of Service invalid in HCSIS). |

| | | |

|954 |125 |Provider ID invalid in HCSIS. This error occurs when the MPI # on the PROMISe claim: |

| | |Is not listed on the consumer's plan, OR |

|Deny | |Is listed on the consumer's plan, but not for the service listed on the PROMISe claim. |

| | | |

| | |Possible Scenarios Include: |

| | |The provider is submitting a claim for a service that another provider renders. |

| | |The Provider is using an incorrect procedure code on the claim. |

| | |The information on the HCSIS plan is incorrect. |

| | | |

| | |Follow menu path ISP > Services and Supports > Svc Dtls to verify that the providers and services on the plan are correct. |

| | |If changes to the providers or services need to be made to the consumer’s plan in HCSIS, refer to the SC tip Sheet 3.0 Services Changes in the Supports |

| | |Coordination course to perform and submit a Critical Revision to the consumer’s plan. |

| | |The day after the critical revision is approved in HCSIS, resubmit the PROMISe claim so it will verify against the updated provider on the consumer’s plan. |

| | | |

| | |Note: If the error occurred because the correct provider is not in HCSIS, follow the program office procedures for adding new providers into HCSIS. Then perform|

| | |a critical revision to the consumer’s plan to add the new provider as instructed in the above steps. Then the provider must re-bill the claim. |

| | | |

|955 |125 |Provider Service Location invalid in HCSIS. This error code applies to PDA and ODP only. |

| | | |

|Deny | | |

| | | |

|956 |31 |Recipient (MCI number) not enrolled in HCSIS. This error occurs when the consumer has a plan in HCSIS, but the plan is not associated to the waiver/program |

| | |applicable to the service on the PROMISe claim. |

|Deny | | |

| | |Follow menu path Individual > Eligibility > Waiver/Program Enrollment. |

| | |Search for the consumer's plan by MCI number. |

| | |Review the waiver/program history for the consumer. |

| | |Follow menu path ISP > Serv & Supp > Svc Dtls. |

| | |Search for the consumer's plan by MCI number. |

| | |Review the plan(s) that exist for the consumer to determine if a new plan for the waiver/program associated to the service on the claim needs to be created in |

| | |HCSIS. |

| | |If a plan needs to be created in HCSIS, reference SC tip sheets 1.0 - 8.0 of the Supports Coordination course. |

| | |If the consumer’s eligibility information needs to be changed, contact the program office’s Eligibility Reviewer role and the consumer’s Supports Coordinator to|

| | |research eligibility. |

| | | |

|957 |125 |HCSIS/PROMISe service program disagreement. This error occurs when CIS lists the consumer in a different service program than HCSIS. For example, if CIS lists |

| | |the consumer in OBRA and HCSIS lists the consumer in the Michael Dallas Waiver, this error appears. |

|Deny | | |

| | |Note: Before a claim comes to HCSIS, PROMISe checks the consumer's eligibility information in CIS on the date of service on the claim. PROMISe then appends that|

| | |eligibility information to the claim and checks for a match in HCSIS in the Eligibility subsystem. |

| | | |

| | |Possible Scenarios Include: |

| | |The consumer transferred waivers and the information in either CIS or HCSIS was not updated. |

| | |The information in either HCSIS or CIS in incorrect. |

| | | |

| | |Contact the program office’s Eligibility Reviewer role and/or the consumer’s Supports Coordinator to research the consumer’s eligibility. |

| | |Follow menu path Individual > Eligibility > Eligibility Determination to review the consumer’s eligibility information. |

| | | |

|958 |45 |Billed amount not equal to contract rate. This error applies to ODP only. |

| | | |

|Deny | | |

| | | |

|959 |125 |ICN (Internal Control Number, a.k.a. PROMISe claim number) not found in HCSIS. When an adjustment claim is entered into PROMISe, the adjustment claim needs to |

| | |reference the original claim that needs to be adjusted. If the ICN for the original claim cannot be found in HCSIS, this error will appear. This error occurs |

|Deny | |when the ICN does not meet certain criteria such as: |

| | |13 digits in length |

| | |all integers |

| | | |

| | |Possible Scenarios Include: |

| | |When attempting to adjust or void a previous claim, the provider entered the original claim number incorrectly. |

| | |The ICN of the claim was not assigned properly for technical reasons (rare). |

| | | |

| | |This is a technical issue and cannot be researched in HCSIS. Research PROMISe to see if the ICN for the original claim is wrong. The adjustment claim will not |

| | |process through HCSIS until it references an original claim that has processed through HCSIS. |

| | |If the provider entered the original claim number on the adjustment claim incorrectly, then the Provider should resubmit the adjustment or void for the claim |

| | |with the correct original claim ICN. |

| | | |

| | | |

|960 |125 |ICN (Internal Control Number, a.k.a. PROMISe claim number) line number not found in HCSIS. This error occurs when the unique identification number assigned by |

| | |PROMISe to the claim line, also called the ICN line number, does not meet certain criteria such as: |

|Deny | |2 digits in length |

| | |all integers |

| | | |

| | |Possible Scenarios Include: |

| | |When attempting to adjust or void a previous claim, the provider entered the original ICN line number incorrectly. |

| | |The ICN line number of the claim was not assigned properly for technical reasons (rare). |

| | | |

| | |This is a technical issue and cannot be researched in HCSIS. Research PROMISe to see if the ICN line number for the original claim is wrong. The adjustment |

| | |claim will not process through HCSIS until it references an original ICN line number that has processed through HCSIS. |

| | |If the provider entered the original ICN line number on the adjustment claim incorrectly, then the Provider should resubmit the adjustment or void for the claim|

| | |with the correct original claim ICN line number. |

| | | |

| | | |

|961 |125 |Previous ICN (Internal Control Number, a.k.a. PROMISe claim number) not found in HCSIS. When an adjustment claim is entered into PROMISe, the adjustment claim |

| | |needs to locate the original claim in HCSIS to reverse it. If there is not an original claim to reverse, this error will appear. |

|Suspend | | |

| | |Once a claim has been paid, it is possible for the provider to need to change the claim. This is done by submitting either an adjustment or void claim, both of |

| | |which include a reference to the original claim being adjusted or voided. This error occurs when the ICN for the original claim cannot be found in HCSIS to be |

| | |adjusted or voided. |

| | | |

| | |Important Note: If an original claim was denied, the provider must submit a New claim. If a claim is suspended, claims resolution staff can either resubmit or |

| | |reject the claim. If resubmitted, it will not be suspended on the same error again. If rejected, the provider must submit a New claim. |

| | | |

| | |Possible Scenarios Include: |

| | |The original claim was not ever processed through HCSIS. |

| | |The provider entered the original claim number incorrectly on the adjustment claim. |

| | |The provider is entering an adjustment or void claim for an original claim that was never paid. If the original claim was suspended or denied, and the provider |

| | |uses the original claim number on an adjustment or void claim to try to fix the error, this error will occur. The provider will need to submit a New claim to |

| | |resolve suspended or denied claim issues. |

| | | |

| | |This is a technical issue and cannot be researched in HCSIS. Research PROMISe to see if the adjustment claim should have been entered into PROMISe as a regular |

| | |claim. The adjustment claim will not process through HCSIS until it references an original claim that has processed through HCSIS. |

| | | |

| | | |

|962 |125 |Previous ICN (Internal Control Number, a.k.a. PROMISe claim number) line number not found in HCSIS. This error is the same scenario as PROMISe error code 961 |

| | |but it applies to an individual service line on the claim, whereas 961 applies to the entire claim. |

|Deny | | |

| | |If a claim has been partially paid, the provider needs to correct the lines that were denied and resubmit the entire claim to receive payment for the denied |

| | |lines. This error occurs when the ICN for the original claim cannot be found in HCSIS to be adjusted or voided. |

| | | |

| | |Possible Scenarios Include: |

| | |The original claim was not ever processed through HCSIS. |

| | |The provider entered the original claim line number incorrectly on the adjustment claim. |

| | |The provider is entering an adjustment or void claim for an original claim that was never paid. If the original claim was suspended or denied, and the provider |

| | |uses the original claim number on an adjustment or void claim to try to fix the error, this error will occur. The provider will need to submit a New claim to |

| | |resolve suspended or denied claim issues. |

| | | |

| | |This is a technical issue and cannot be researched in HCSIS. Research PROMISe to see if the adjustment claim should have been entered into PROMISe as a regular |

| | |claim. The adjustment claim will not process through HCSIS until it references an original claim that has processed through HCSIS. |

| | | |

| | | |

| | | |

|963 |38 |Direct Care Provider invalid. This error applies to ODP only. |

| | | |

|Deny | | |

| | | |

|964 |125 |County not enrolled in HCSIS. This error applies to ODP only. |

| | | |

|Deny | | |

| | | |

|966 |42 |Rate approved less than billed. This error does not prevent the claim from processing. It is an informational error to inform you that the service rate on the |

| | |consumer’s plan in HCSIS is less than the service rate that the provider billed in PROMISe. HCSIS automatically approves the lower of the two rates, so the |

|Pay | |claim will be approved for payment with the service rate on the consumer’s plan. |

| | | |

| | |Possible Scenarios Include: |

| | |The claim is correct, but the service’s rate on the plan is incorrect. |

| | |The service’s rate on the claim is incorrect; the service’s rate on the plan is accurate. |

| | |Critical revision is in progress and has not been completed. |

| | | |

| | |Follow menu path ISP > Services and Supports > Svc Dtls to verify the rate in HCSIS. |

| | |If the rate is incorrect in HCSIS, follow Program Office procedures to change the rate in HCSIS. |

| | |If the rate is changed in HCSIS, refer to SC tip sheet 3.0 Service Changes of the Supports Coordination course to perform a critical revision to decrease the |

| | |units for the old service rate and add the updated service to the consumer’s plan. |

| | | |

| | |Note: Since the claim already processed through HCSIS successfully, the provider will have to file an adjustment claim in PROMISe so the units for the old |

| | |service rate on the consumer’s plan in HCSIS can be reduced during the critical revision. Then the provider can resubmit the claim through HCSIS after the new |

| | |rate is added to the consumer’s plan. |

| | | |

|967 |42 |Units approved less than billed. This error does not prevent the claim from processing. This error occurs when there are not enough units on the consumer’s plan|

| | |in HCSIS to cover the number of units on the PROMISe claim. HCSIS will approve payment for as many units that are remaining on the plan. |

|Pay | | |

| | |Possible Scenarios Include: |

| | |The claim is correct, but the number of units on the plan is incorrect. |

| | |The number of units on the claim is incorrect; the units on the plan are accurate. |

| | |Critical revision is in progress and has not been completed. (See below) |

| | | |

| | |Research the claim to determine if the units on the consumer’s plan need to be increased. |

| | |Use the HCSIS Expense Summary screen to determine the number of remaining units on the plan at the time of the claim. The Individual Benefit Detail Report will |

| | |also display remaining units as well as the claim transaction history. |

| | |If you need to change the service’s units in HCSIS, refer to the SC tip sheet 3.0 Service Changes in the Supports Coordination course to perform and submit a |

| | |Critical Revision to the consumer’s plan. |

| | |The day after the critical revision is approved in HCSIS, the provider can file an adjustment claim in PROMISe so it will verify against the new units on the |

| | |consumer’s plan. |

| | | |

|968 |125 |HCSIS/PROMISe service program mismatch ODP/EI. This error code applies to ODP only. |

| | | |

|Susp. | | |

| | | |

|969 | |HCSIS/PROMISe service program change. This error code applies to ODP only. |

| | | |

|Pay | | |

| | | |

|970 | |Procedure (service) priced using HCSIS fee schedule. This error does not prevent the claim from processing. This error occurs when the claim is processed based |

| | |on the fee schedule set by OLTL or PDA. |

|Pay | | |

| | | |

|971 | |Procedure (service) has zero units available. This error occurs when the claim’s service has zero units available in the HCSIS plan. |

| | | |

|Deny | |Possible Scenarios Include: |

| | |There are zero units remaining on the plan. Provider would not be paid for any units in this case. |

| | | |

| | |Research the claim to determine if the units on the consumer’s plan need to be increased. |

| | |Use the HCSIS Expense Summary screen to determine the number of remaining units on the plan at the time of the claim. The Individual Benefit Detail Report will |

| | |also display remaining units as well as the claim transaction history. |

| | |If you need to change the service’s units in HCSIS, refer to the SC tip sheet 3.0 Service Changes in the Supports Coordination course to perform and submit a |

| | |Critical Revision to the consumer’s plan. |

| | |The day after the critical revision is approved in HCSIS, the provider can file an adjustment claim in PROMISe so it will verify against the new units on the |

| | |consumer’s plan. |

Appendix D: Web Browser Settings and Encryption

Web Browser Settings

To verify that your web browser is displaying properly, navigate to the HCSIS home page at HCSIS.state.pa.us and confirm that it displays as shown below.

Example of the HCSIS home page displaying correctly:

[pic]

If a user’s PC cannot access the HCSIS home page, contact your organization’s network administrator and request that HCSIS be added to your organization’s list of approved web sites.

Web Browser Encryption

To check if a browser using Internet Explorer has 128 bit encryption, perform the following steps:

1. Open the web browser.

2. Click Help in the toolbar at the top of the screen

[pic]

3. Select About Internet Explorer.

[pic]

4. Check the line labeled Cipher Strength to determine the level of encryption that your browser supports. If the Cipher Strength is 128 bit, the browser will be able to access HCSIS. If the Cipher Strength is not 128 bit, the browser will have to be upgraded.

[pic]

To upgrade an Internet Explorer web browser that does not support 128 bit encryption, visit the following website ([pic]) to download the most current 128 bit encryption version of IE that maximizes online security. The length of time for the download depends on the speed of the Internet connection.

Appendix E: Troubleshooting Slow Access to HCSIS Site

Steps for Troubleshooting

1. Ask your organization’s technical support to:

• Check the personal computer configuration

• Check browser settings

• Check connection between the personal computer and the LAN

• Check the connection between the LAN and the Internet Service Provider

2. Ask technical support if:

• There have been changes to LAN (new or upgraded software and/or hardware, new cables, new routers, etc.)

• There have been changes with the Service Coordination Provider’s connection to the Internet Service Provider (ISP), or the ISP’s connection to the Internet

3. Call the HCSIS Help Desk, 1-866-444-1264, to report slow response time if no explanation can be found.

Please use the following to chart when calling the Help Desk regarding a slow response time, as it will assist the Help Desk in locating the source of the performance problem. When it takes longer than normal to go between one screen and another, it is important to know where the slow-down is occurring so that the source of the problem can be identified.

To use the tool, visit the each site in succession, tracking the response times. Then, call the HCSIS Help Desk and provide the information on the site response times. Help Desk personnel will work with you to identify the performance problem and have it addressed by the appropriate team.

|Go To |Web Site Address |Elapsed Time (min/sec) before |Date & Time |

| | |screen is displayed | |

|Google | | | |

|DPW Home Page |dpw.state.pa.us | | |

|COMPASS | | | |

|HCSIS System Acceptance | | | |

|Test (SAT) | | | |

|HCSIS Production (Live | | | |

|System) | | | |

-----------------------

The Glossary of Terms provides a description of the common acronyms used to describe or explain a component of HCSIS.

The Help Desk FAQ lists answers to common questions submitted to Help Desk staff. Users should refer to this list for answers to basic questions and should continue to contact the Help Desk for any additional assistance needed.

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In order to avoid copyright disputes, this page is only a partial summary.

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