Fee-For-Service Authorized for SSN
(Also Reject Code 56 and Reject Code 7A)
Possible causes for rejects:
- The individual is not authorized for the service or is not yet authorized.
- The individual is authorized but there is a Social Security Number mismatch and the bill is unable to connect with the authorization.
Individual Not Authorized For Service
- Providers must have a written award letter from the Division of Developmental Disabilities to document approval for services to begin.
- Providers must have an accepted case information in the DHS system for an individual's services to be authorized.
- Even if there are no delays, it may take up to a month after an award letter is issued for the authorizations to be transmitted to the payment system.
Ways to verify that the authorization has been processed and some common reasons for delays in processing:
- Verify that an award letter was received by the guardian and Independent Service Coordination/Pre-Admission Screening (ISC/PAS) agency (and the CILA provider, if applicable) at least a month before the bill was rejected. If it has been less than a month, wait and resubmit the bill.
- Verify via the computer-generated "Guardian Notification of Service Authorization and Financial Liability" as to which services are authorized, and the SSN of the authorizations. It may be necessary to contact another provider or the guardian to check this form.
- For people receiving CILA services:
- Check that the residential provider has contacted the Bureau of Accreditation, Licensure, and Certification (ALC) to approve the home.
- For new CILA providers, check that the residential provider has submitted an acceptable individual service plan to the Bureau of Quality Management for approval.
Social Security Number (SSN) Mismatch Prevention
It is critical that all providers serving the same individual use the correct Client ID and SSN. The correct SSN is the one that both the Social Security Administration and the DHS local office Medicaid Management Information System (MMIS) use.
- Make sure that the SSN is correct on the ROCS case information and bills.
- Get and keep a copy of the individual's Social Security card and make sure it is legible.
Note: Do not rely on the SSN on the person's Social Security check. That number is frequently the SSN of the individual's father or mother.
Note: Some individuals have more than one SSN. In that situation, the DHS local office, SSA, and all providers must agree on which one to use.
SSN Mismatch Correction
Compare the Client ID (SSN) on ROCS with:
- The SSN on the individual's Social Security Card (not the SSA check).
- The SSN for the individual on the HFS Medicaid database. You can call the Toll-Free Number or use the MEDI Web Site to verify the SSN.
- The SSN on the award letter sent by DHS. If the SSN on the award letter is not correct, please contact the Bureau of Community Reimbursement at 1-217-782-0632. They may request that you fax a copy of the Social Security Card.
- The SSN on the computer-generated "Guardian Notification of Service Authorization and Financial Liability." (Report M0446092, available through Mobius)
- The SSN used by the DHS local office as confirmed by the hotline or the caseworker.
- If the SSN used by the DHS local office is not correct, contact the DHS local office to correct it or to submit a Discrepancy Referral (DPA-1925) to find out which SSN should be used.
Note: Bills for covered Waiver services that do not match the SSN used by the DHS local office will be rejected because the individual appears not to be enrolled in Medicaid.
Complete a Change Client ID
Complete a "Change Client ID" on the case information in ROCS, if ROCS has the wrong Client ID. The "Change Client ID" will correct the Client ID (SSN) on the case information and on all pending, rejected or accepted bills and service reporting. Transmit the case file to DHS.
- The "Change Client ID" can only be completed after you have updated your PC system with a results file and before you create a new file for transmittal.
- The "Change Client" will not work if there are bills or service reporting in submit status.
- If you create a new case information instead of correcting the wrong existing case information, you will have to correct the SSN on every bill to be paid.
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