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MACSIS Site Map

Claims | Codes | Contacts | Extracts | FAQ's | Forms | Manuals | Meetings | Member | Payment | Policies | Prod. Schedules | Reports | Technical

MACSIS Home

• ACT/IHBT Information
• Link to Hurricane Katrina Documents/Communications
• Macsis Support (E-mail)
• Macsis Support - Phone 1-877-462-2747

ODADAS Home

• Behavioral Module
• MAC-Search

Claims and Related Documents

• APUPD Process
• APUPD Weekly Schedules and Status
• BENEF Explanation Sample
• Board Operations Manual - Claims Section (large file)
• BRULE Explanation 
• BRULE Explanation Sample
• Caution/Outlier/Notify Reports Documentation
  • HIPAA Notify Program (large file)
• Cheat Sheets and FAQ's
• Claims and Payment Training (PDF, large file) (PowerPoint, large file)
• Claims Billing, Weekly Schedules and Status
• Claims Contacts (by Name) (by County)
• Claims EDI File Processing for the 837P in MHHIPAA 
• Claims Extract Layout 
• Claims Post Report Layout (102 ASCII File) 
• Codes
• Contracts, Pricing & Adjudication Training (PDF) (PowerPoint)
• Contract, PSCHD & Procedure Code Tables 
• Denying Claims Beyond Submission Deadline, Procedure for 
• Fixing Retroactive Medicaid-Eligible Claims 
• FY03 Claims Data For Testing (Excel) (PDF)
• HIPAA Price Schedules (Excel) (PDF)
• HIPAA Service Rate Form (Tier 2)
  • ODADAS Service Codes (Excel) (PDF)
  • ODMH Service Codes (Excel) (PDF)
  • HIPAA Service Rate Form (Tier 2) Instructions 
• MACSIS HIPAA Claim Correction Policy 
• MACSIS HIPAA Claim Correction Procedure 
• MACSIS HIPAA Claim Correction Form (PDF) (Word)
  • Instructions for Completing MACSIS HIPAA Claims Correction Form 
• MACSIS Testing Information
  • MACSIS HIPAA EDI Claims Testing & Approval Policy 
  • Submit Test MACSIS EDI Claim File for Approval Procedure 
  • MACSIS EDI Claims Testing Request Form (Word) (PDF)
  • NPI Claims EDI Checklist 
• MACSIS Performance Overview - By Boards Documentation 
• MACSIS Technical Informational Guides
  
  • 837 Professional Claim v4010 - NPI Format 
    • Sample 837 NPI Format 
  • 835 Health Care Claim Payment Advice - NPI Format 
    • Sample 835 NPI File 
• Member/Claims Transfer Request Form (PDF) (Word)
  • Member/Claims Transfer Instructions 
• MH Same Day Service Reporting - Roll-Up Categories for Duplicate Checking 
• Naming Conventions
• ODADAS Roll-Up Categories for Duplicate Checking 
• Overnight File Program 
• Provider (PROV) Information Listing
• Timelines
  • AOD OHEXT/CPE Process Timeline 
  • APUPD Process Timeline 
  • ODMH OHEXT/CPE Process Timeline 
  • Claims Process Timeline 

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Codes and Related Documents

• Affiliation Codes
• AOD HIPAA Modifier Code Table
• AOD HIPAA Procedure Code Table 
• AOD Procedure Code, Modifier and Medical Definitions Matrix 
• BENEF Explanation (Sample)
• BRULE Explanation 
• BRULE Explanation (Sample)
• Contract, PSCHD & Procedure Code Tables 
• Diagnosis Codes - Valid BH ICD-9-CM Under HIPAA 
• Diamond PREDI Error Codes (HIPAA) 
• Diamond Reason Codes (HIPAA)
• Medical Definitions for FY05 
• MH HIPAA Modifier Code Table 
• MH HIPAA Procedure Code Table 
• MH Procedure Code Table Explanation 
• Naming Conventions
• ODADAS Terms and Definitions 
• ODMH Procedure Code, Modifier and Medical Definitions Matrix 
• ODMH Residential Housing Service Categories 
• Place of Service Codes
• Procedure Codes and Affiliated Price Schedules 
• Remittance Code Sets
  • Crosswalks
    • Diamond 8+ to HIPAA 835 Reason Codes 
    • Diamond 8+to HIPAA 835 Default Reason Codes 
    • HIPAA 835 to Diamond 8+ Reason Codes (Reverse Crosswalk)
  • HIPAA (835) Code Sets
    • Claim Adjustment Group Codes
    • Claim Adjustment Reason Codes
    • Claim Filing Indicator
    • Claim Status Code
    • Health Care Remark Codes
  • ODJFS
    • ODJFS Errors Returned from Double-Loop
    • MCP Enroll/Disenroll Codes 
• Service Population Codes 
• TASC Build Description 

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Contacts

• Claims Users' Group
• Finance Team Members
• Member Users' Group
• MIS Team Members
• Project/Operations (POP) Team

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Extracts and Related Information

• Affiliation File Extract Layout 
• Caution/Outlier/Notify Reports Documentation
  • HIPAA Notify Program 
• Claims Extract Layout 
• CPE File Layout 
• Claims Post Report Layout (102 ASCII File) 
• MACSIS Performance Overview - By Boards Documentation 
• MCP Extract Layout and Field Definitions
• Member & Eligibility File Extracts & Subset Construction 
• New and Old Claims Extract Layout 
• New and Old Member Extract Layout 
• Provider/Vendor File Layout 
• Short Claims Extract Layout (Excel) (PDF)
• Short Claims Extract Layout with Field Description 

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FAQ's and Cheat Sheets

• Claims
  • APUPD Process 
  • BRULE Explanation 
  • Claims EDI File Processing for the 837P in MHHIPAA
  • Contracts and Pricing Flowchart 
  • Contract, PSCHD & Procedure Code Tables 
  • Correcting OHIO Claims - MBRIN 
  • Correcting OHIO Claims - PRVIN 
  • Denying a Claim
  • Denying Claims Beyond Submission Deadline, Procedure for 
  • FAQ - Claims
  • Fixing Retroactive Medicaid-Eligible Claims 
  • Life Cycle of a Claim Flowchart
  • Life Cycle of a Claim Documentation 
  • Making a Denied Claim Payable 
  • Putting a Claim on Hold 
  • Reporting Third Party Insurance on the 837P 
  • Reversing a Claim 
  • Sample 835 v4010 UPI File 
  • Sample835 v4010 NPI File 
  • Sample 837P v4010 UPI File 
  • Sample 837P v4010 NPI File 
  • Splitting a Claim
  • Un-Pending Claims 
• Timelines
  • AOD OHEXT/CPE Process Timeline 
  • APUPD Process Timeline 
  • ODMH OHEXT/CPE Process Timeline 
  • Claims Process Timeline 
• Member
  • Completing the Member Screen 
  • Enrolling a Client 
  • FAQ - Electronic Eligibility Inquiry
  • FAQ - Member
  • FAQ - Member & Medicaid Eligibility FAQ
  • Residency Determination Cheat Sheet 
  • Search for a Member 
• MACSIS Naming Conventions
• Reports List (all MACSIS reports) 

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Forms

• Account Request Form 
• Claims Correction Form, MACSIS HIPAA (Draft) (PDF) (Word)
  • Instructions for Completing MACSIS HIPAA Claims Correction Form 
• Disclosure of Information Form (Board Staff) 
• HIPAA Service Rate Form (Tier 2) (May 7, 2003)
  • ODADAS Service Codes (Excel) (PDF)
  • ODMH Service Codes (Excel) (PDF)
  • HIPAA Service Rate Form (Tier 2) Instructions
• MACSIS EDI Claims Testing Request Form (PDF) (Word)
• Member/Claims Transfer Request Form (PDF) (Word)
  • Member/Claims Transfer Instructions 
• Member Enrollment Form 
  • Member Enrollment Form Instructions 
• Provider Request Modification Form (Word) (PDF)
• Report Request Form 
• Request to Remove Client From MACSIS Form 
• Residency Dispute Determination Form - ADM038 
• Residency Verification Form 
• TCP/IP Access Request Form (Unix Accounts) 

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MACSIS Manuals

• Board Operations Manual - Claims Section (large file)
• Board Operations Manual - Member Section (large file)
• Diamond 725 Documentation: HSD's Documentation, mostly in individual Word files, is available by FTP to qualifying Boards/Consortium entities. Note these are copyright materials and are considered "trade secrets." FTP access to obtain these can be arranged through Kendall Fells.
• Guidelines Pertaining to the Implementation of MACSIS under HIPAA 
• Guidelines & Operating Principles for Residency Determination Among CMH/ADAS/ADAMHS Boards
• Project Technical Documentation

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Meetings & Minutes

• Behavioral Module Meeting Minutes
• Pop Meeting Minutes

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Member Related Information and Documents

• Affiliation Codes Explanation 
• Affiliation File Extract Layout 
• Board Operations Manual - Member Section (large file)
• Cheat Sheets and FAQ's
• Enrollment Contacts (by Name) (by County)
• Member Enrollment Form 
  • Member Enrollment Form Instructions 
• Enrollment Procedures, MACSIS Support Desk
• Guidelines Pertaining to the Implementation of MACSIS under HIPAA 
• Member/Claims Transfer Request Form (PDF) (Word)
  • Member/Claims Transfer Instructions 
• Member & Medicaid Eligibility FAQ
• Member Error Reports 
• Member FAQ
• Member Training (PDF, large file) (PowerPoint, large file)
• New and Old Member Extract Layout
• Removal of Client Data from MACSIS 
  • Request to Remove Client from MACSIS Form 
• Residency
  • Dispute Determination Process Instructions for Executive Directors
  • Guidelines & Operating Principles for Residency Determination among CMH/ADAS/ADAMHS Boards
  • Out-of-County Enrollment Process
  • Residency Verification Form

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Payment Related Documents

• APUPD, Check Post, Claims Reports
• Diamond Reason Codes
• Double Loop Diagram 
• Finance Guidelines
• MH ARA and Voucher Explanation
• Production Schedule
• Remittance Information
  • Code Sets
  • Electronic Remittance Advice (ERA)
  • Paper Remittance Reports
  • MACSIS 835 Health Care Claim/Payment Advice Companion Guides
• Timelines
  • AOD OHEXT/CPE Process Timeline 
  • APUPD Process Timeline
  • ODMH OHEXT/CPE Process Timeline 
  • Claims Process Timeline

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Policies & Guidelines

• Change Control Policy 
• Guidelines Pertaining to the Implementation of MACSIS under HIPAA
• Removal of Client Data from MACSIS 
  • Request to Remove Client from MACSIS Form
• Finance Guidelines
• Board Operations Manual - HIPAA Claims Section (large file)
• Board Operations Manual - HIPAA Member Section (large file)
• MACSIS Board-State BAA/TPA 
  • Addendum to TPA
• Residency
  • Dispute Determination Process Instructions for Executive Directors
  • Enrollment Procedures - MACSIS Support Desk
  • Guidelines & Operating Principles for Residency Determination among CMH/ADAS/ADAMHS Boards
    • Appendix A - Guidelines used in Determining County of Residence for College Students
    • Criminal Justice System and Residence Determinations
  • Out-of-County Enrollment Process
  • Out-of-County Enrollment Letter
  • Out-of-County Enrollment Summary Matrix
  • Residency Dispute Determination (RDD) Process
  • Residency Dispute Determination (RDD) Request Form 
  • Residency Verification Form 

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Production Schedules

• MACSIS Production Schedule Information
• Schedule of Explanations
  • Schedule Basics
  • MACSIS Schedule Definitions and Regular Run Times 
  • Board Claim Edit Groups

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Reports

• MACSIS Reports List 
  • Spring 2005 FMG Reports Presentation (PowerPoint, large file) (PDF, large file)
• APUPD
  • Current Week 
  • Previous Week 
• Check Post
  • Current Week 
  • Previous 1 
  • Previous 2 
  • Previous 3 
• Claims Billing
  • Finalized Claims by Company (Board) & UPI (Provider) (large file)
  • Finalized Claims by UPI (Provider) and Company (Board) (large file)
• Claims Status Reports by Provider
  • Provider List Sorted by Name
  • Provider List Sorted by MACSIS UPI (Provider Number)
• Claims Remittance Tracking Reports by Provider
  • Provider List Sorted by Name
  • Provider List Sorted by MACSIS UPI (Provider Number)
• Weekly Claims File Submissions by Board
  • Documentation of Reports
  • Current Week 
  • Previous Week 1 
  • Previous Week 2 
  • Previous Week 3 
• Weekly Claims File Submissions by Provider
  • Documentation of Reports
  • Current Week
  • Previous Week 1
  • Previous Week 2 
  • Previous Week 3

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Technical Documents

• Account/Login Form 
• Account Request Form - UNIX OSG-DAS TCP/IP Access Request 
• Account User Request Spreadsheet
• Caution/Outlier/Notify Documentation - HIPAA Notify Program 
• Claims Post Report Layout (102 ASCII File)
• CPE File Layout 
• Determine Your IP
• Disclosure of Information Form (Board Staff)
• EOL Issues
• Pricing for Boards (File Layout)
• Extracts
  • Affiliation File
  • Claim Related
  • New and Old Claims Layout 
  • Member Eligibility 
  • New and Old Member Layout 
  • Short Claims Extract Layout
  • Short Claims Extract Layout with Field Descriptions
• FTP Accounts and Directories 

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