Out of County Enrollment Process
Step 1 Provider determines client’s county of residence.
It is the Provider’s responsibility to obtain sufficient documentation to determine the client’s county (Board) of residence. It is in everyone’s best interest for the provider to obtain as much information as possible to assist in the residency determination process. This information is essential to quickly and correctly identifying a client’s correct residence.
Step 2 Provider completes enrollment form, after client has signed release and authorization to bill.
The Provider is responsible for discussing the Notice of Enrollment with the client and obtaining all releases and disclosures per the confidentiality guidelines.
Step 3 Provider faxes form to enrollment center for the board where the client resides.
Once the Provider has determined the residency of the client, the Provider must fax the enrollment form to that Board’s enrollment center to begin the enrollment process. The Provider must indicate on the enrollment form that releases have been obtained for that specific Board area.
Step 4 Board enrolls the client or works with the provider to clarify questions.
Upon receipt of an enrollment form from a Provider that is treating a client who is a resident of that Board area, the Board’s enrollment center should look up the client, enroll the client if not already in MACSIS, and then return to the provider the client’s UCI, plan assignment and rider information. If there are points of clarification, the Board is responsible for making contact with the Provider to resolve any questions.
Step 5 Board faxes back UCI to provider.
It is recommended that no more than 5 business days (1) should separate the faxing of the enrollment form from the provider to the board and the receipt of the UCI by the provider. The provider will then use the UCI to bill for services. Medicaid clients receiving Medicaid certified services will be paid and non-Medicaid clients and non-Medicaid services will be subject to the Out of County guidelines.
Step 1 Provider follows Normal Enrollment Process
In all cases, the Provider should follow the process established for a normal out of county enrollment. It is in everyone’s best interest for the provider to obtain as much information as possible to assist in the residency determination process. This information is essential to quickly and correctly identifying a client’s correct residence. Examples of documentation that can be used to establish a client’s residency include:
- Driver License
- State ID Card
- Lease agreement
- Adoption or custody papers
- Statement from Client (Signed and Witnessed) Indicating Residency
Step 2 Board of Residency Refuses to Enroll an Out of County Client
If the Board (where the Provider determines the client resides) refuses to enroll the client or fails to provide a UCI within ten business days, the provider should contact the MACSIS Support line.
Step 3 MACSIS Support Line Enrolls Client
The Provider will provide the MACSIS Support line with copies of the enrollment form and all supporting information that was provided to the Board. As soon as the proper documentation has been received, the MACSIS Support Line staff will send an email to the affected board and wait 1 working day before doing the enrollment. This is to provide time for the affected board to become aware of the issue. (2)
The MACSIS Support Line staff will enroll the client in a generic plan of the Board where the client resides. The MACSIS Support Line will follow the rules as outlined in the Summary Matrix that was included in the December 7, 1999 joint memo from Carolyn Givens and Rick Tully titled: Out-of-County MACSIS Enrollment. A copy of the body of that memo will be included as an attachment to this Guideline.
Note: Providers should be aware that non-Medicaid clients that are not in Crisis WILL NOT be enrolled per the Summary Matrix included in this notice.
The MACSIS Support line Staff will then electronically notify both the Board where the client has been enrolled and the provider that is treating the client, with the enrollment information.
Step 4 Residency Dispute Claim Submitted
If the board where the client is enrolled disputes the residency determination and action taken by the MACSIS Support Line, the Board may file a formal residency dispute following the established RDD Guidelines.
(1) The expectation remains that the majority of enrollments will occur within two (2) to five (5) days. It is understood, however, that exceptional circumstances will occur, particularly with out-of-county enrollments. In no event, however, should any enrollment, in-county or out-of-county, take longer than ten (10) days.
(2) The Macsis Support Line is not responsible for settling residency disputes and therefore, should not be expected to respond to board disputes which might result from the e-mail notification. They will continue, as outlined in this procedure (i.e., enrolling the client) and the disputing board must then file the appropriate dispute as noted in the RDD guidelines.