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This articles explains how Supervisors can manage their Financial Workload in Ohio SACWIS.
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Discusses how Eligibility Specialists can manage their Financial Workload in Ohio SACWIS.
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Important: Submit to all TPL Providers Before Submitting to Medicaid.
Counties: If you have problems with third party insurers when providers submit billings to Medicaid with content such as "Please submit to all TPL providers before Submitting to Medicaid," please redirect them to the following TPL e-mailbox:
Report TPL (Third Party Liability) problems to:
These are not SACWIS or FACSIS Medicaid issues, nor can we make any corrections to their third party medical insurance information.
Refer to the attachment for additional information.
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Question: Where does resource information come from? Is it the caseworker entering information on the profile screen or is it all from CRIS-E?
Answer: The caseworker enters the information in the Person module, under the Resource tab. If the data was transferred for the person in the CRIS-E case, the query to CRIS-E will then populate data on the Resource tab in the Person module screens in SACWIS. The caseworker will have the ability to end date or invalidate the resource record for data that is found in CRIS-E.
Question: On the Reimbursability screen, where is all the financial information coming from? Again is this from the caseworker entering information on the Profile screen or is it from CRIS-E?
Answer: The financial information on the Reimbursability screen comes from the Employment Information link in the Person module. This data must be entered by the caseworker. Data will populate in SACWIS from CRIS-E if data for the CRIS-E case member has been transferred.
Question: In the situation where a child is not eligible for Title IV-E, how do we apply for Medicaid through SACWIS?
Answer: You cannot apply for Medicaid through SACWIS for Non IV-E children. You have to apply for Healthy Start. However, in SACWIS you can record that an application was sent to JFS.
Question: How will we do annual redeterminations on children? We couldn't find a place for this in SACWIS.
Answer: Program eligibility redeterminations do not need to be performed in SACWIS. The system will automatically generate a program eligibility redetermination record when the child turns 18 and the worker will receive a tickler about it. Per policy, annual reimbursability redeterminations no longer need to be completed. However, annual reasonable efforts reimbursability redetermination still need to be completed and the system will automatically generate one when it is due. You also have the ability to add one if the system did not create one when needed.
Question: When a child goes on AA does FCM close automatically?
Answer: An adoption case must be created for a child who goes from FCM to AA. However, creating an adoption case will not terminate FCM because a child can continue to be placed in a foster home even after the adoption case has been created. For a child to receive AA, he/she must be placed in an adoptive placement. Therefore, the child will no longer be in a foster care placement. However, the system does not automatically terminate FCM reimbursability when the placement changes. A notification is sent to the eligibility specialist about the placement change. The eligibility specialist then needs to terminate the reimbursability. System functionality changes now allow the user to continue paying foster care payments while the child is placed in an adoptive home.
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Question: When does the Service Authorization screen populate with dollar amounts?
Question: Contracted money amounts are not listed on authorization screen. Why?
Answer: When the Service Authorization is created from either the Placement Record or Case Service Record, it will have one of three Cost Types associated to it: Contracted, Standardized, or User Defined.
The following Cost Types will be identified on the Service Authorization:
1. Contracted - This means the service being provided is associated to a network provider with a contract set up in SACWIS that has costs associated to the service. If the cost type on the service authorization is Contracted then the dollar amounts will pre-fill the Maintenance and Administrative fields on the service authorization.
2. Standardized - This means the service being provided is associated to an agency's foster home where services have been set up in SACWIS with costs associated to the service. If the cost type on the service authorization is Standardized then dollar amounts will pre-fill the Maintenance and Administrative fields on the service authorization.
3. User Defined - This means the system needs to validate that the service being provided has an associated service cost record or has been defined in the system as a service that the provider offers. The Maintenance and Administrative fields on the service authorization will display as 0. The Basic Cost field will be enabled allowing the service authorization worker to enter the amount that was paid to the provider.
If dollar amounts do not display at all it could mean there is a discrepancy that needs to be corrected by the appropriate county agency worker. Discrepancies may include the following:
1. The service on the placement record does not match a service in the contract. Verify the placement service for the child has been set up as a service on the network provider's contract that has been set up in SACWIS.
2. The contract begin / end dates, or the service cost begin / end dates set up in the contract for the network provider, have expired and are outside of the placement period.
3. The system does not consider the placement to be purchased care and is therefore not looking for a contract. (The system considers all CRC, Group Home, and Residential Parenting Facilities placements to be purchased care, as well as all foster home placements where the recommending agency is not a PCSA.)
4. If the cost type is Standardized, verify the service has been set up in SACWIS with an associated cost in the Maintain Services area.