According to the Department of Medical Assistance Services (DMAS), the fix to the patient pay calculation/communication issue in the new eligibility system was implemented over the Memorial Day weekend.

The fix has been necessary since September 2015 when local departments of social services began processing new LTC applications in the Virginia Case Management System (VaCMS – the eligibility system).  With the use of VaCMS, the patient pay information did not all come over to the Medicaid Management Information System (MMIS – the claims processing system).  As a result, providers could not accurately bill for services rendered utilizing the automated patient pay data.

The Virginia Department of Social Services (DSS) had been advising local eligibility staff to send patient pay amounts to providers so that the money could be collected.  DMAS also put in place a process for local staff to send patient pay correction requests directly to DMAS for manual entry of patient pay information into the MMIS for any case processed since September where patient pay was not showing up in the system.

The fix implemented this past weekend provides local department of social services workers the ability to accurately calculate patient pay on new applications and have the amounts for all months in the application period sent over to the MMIS.  Action taken on applications prior to the date of the fix will still need to have DMAS staff correct patient pay in the MMIS.  Staff in local agencies will need to continue to send those forms in to DMAS for action to be taken and for patient pay for the prior months to show up.  However, there should not be an issue for cases processed in VaCMS going forward.

VHCA has requested clarification around any claims reprocessing and credit balance audits related to the patient pay issue from September 2015 through the current system fix.  We will continue to update you on this issue.