VaCMS
Where are case notes added?
Under Data Collection
When searching for a case in MMIS, what radio button should you select on the main screen to be able to type in the client's SSN or Medicaid number?
Enrollment
What system(s) do you utilize to IDP?
VaCMS and/or MMIS
If a deeming was completed more than 30 days ago and no changes need to be made, what process do we follow?
General Escalation
In what system is the newborn deeming form located?
MMIS
Where do you look for an NOA or VCL?
Forms -> View Forms History
How do you locate a client's MCO?
Member-> MC Assign -> select radio button next to active MCO -> Prov Loc
You are able to verify a clients address in MMIS but it is different in VaCMS. Do they still pass IDP?
Yes
A woman calls in to apply for Medicaid and states she is pregnant. How long do you advise this application can take to be processed?
7 days
A caller is wanting to change their MCO. Where do you refer them?
Managed Care Helpline
Where do you look to see if we received a client's documents that they sent in response to a VCL?
DMIS -> Document Forms Search
A client calls saying their MA is not paying for their prescription. You look and see that they do have an active case w/ an MCO. What should we look for next and where do you go?
We should look for a TPL and you will click TPL Sum (review this information) and then select TPL Resource for additional details.
A caller gives you a DOB and it is one day off from what you see. The error appears to be a typo. Can they still pass IDP?
No
If a deeming was completed but changes need to be made, what process do we follow?
RMC
A client is having an issue with getting their bill covered. You see they do have active coverage for the time of service but they were under FFS. Where do you send them for assistance?
DMAS Recipient Helpline
Where do you locate a client's case worker information?
RDE -> Search case, open their active case, top right of the screen
What option should you select while viewing a client's case to see what case in VaCMS they are associated with per MMIS?
Case and the VaCMS ID will be located towards the top of the screen.
If a caller is unable to pass IDP, what do you offer (hint: there are 3 things we can offer them)?
General information, LDSS (main number) or a new application.
A woman is applying for coverage and states that she is in a high risk pregnancy. What should you also do with her application?
Escalate as a PW emergency
A client calls in and they are still listed under their mother's case (aka the mother is the case head) and the client is needing to update their address. Are they able to do the RMC and why?
No, the case head, spouse of the case head (if on file) or an authorized representative are the only ones allowed to make changes to the case.
Where do you look to see if a newborn deeming was already completed?
My Workspace ->Newborn-> Newborn Inbox
What code do you input to re-issue a new MA card in the re-issue reason field?
L
What is the Core 4 for IDP?
Name, DOB, SSN, and Address
A mom calls in to add her 18 month old to her case. What type of call/application procedure do you follow?
New application (note: If a renewal is due on the case, you can add a new member during the renewal).
A caller has a TPL on file that they are stating they no longer have and are wanting it removed. Where do you refer them?
Their case worker (note: if CW is unresponsive, you can refer to CW supervisor. If the supervisor in unresponsive, refer to DMAS Recipient Helpline)