Enki Health & Research Systems, Inc. Client Financial ...

1 Enki Health & Research Systems, Inc. Client Financial services manual table of Contents 1 Section One: UMDAP Procedures & Information EHRS Policy Regarding UMDAP Proof of Identification and Social Security Cards Client Intakes Policy & Procedures Transfer of Coordinator Policy & Procedures Copy of Client Face Sheet Copy of Open Episode Face Sheet Copy of Disposition Screening Scheduled Appointments Client Financial services Dept. Follow-ups Conservators or Legal Guardians and Foster Care Information Policy & Procedures Proof of Conservator or Legal Guardian Form Proof of Foster Care Financial Screening Checklist Policy & Procedure Financial Screening Checklist Form (CFS-001) State Medi-Cal Website Information Medi-Cal Aid Codes Policy & Procedures Aid Codes Master Chart Logon and Access to LA County IS system Logon and Access to ENKI CMS system School Based and Home Based Procedures Medi-Cal Verification Policy & Procedures County Code List Copy of Medi-Cal Benefits Identification Card AEVS Response Log Medi-Cal Eligibility Inquiry Log Policy & Procedures Copy of Medi-Cal Inquiry Log (CFS-002) Medi-Cal Batches Policy & Procedures Samples of Medi-Cal and IS / CMS Screens Medi-Cal Eligible with no Share of Cost (SOC) Medi-Cal Eligible with no SOC and Other Health Coverage (Private Insurance)

2 Medi-Cal Eligible with no SOC and Medicare Part A&B Medi-Cal Eligible with no SOC, Medicare Part A&B, with OHC HMO Medi-Cal Eligible with no SOC HMO Medi-Cal Eligible with no SOC and OHC (Private Insurance) Medi-Cal Eligible with a Share of Cost Medi-Cal SOC Policy & Procedures Medi-Cal SOC or FC Form Completed Sample of Medi-Cal SOC or FC Form (CFS-003) How to Perform a Medi-Cal SOC Transaction SOC Write-Off Response SOC Cleared Certified Identifying Medi-Cal SOC in CMS and IS No Medi-Cal Eligibility Healthy Families Healthy Families Policy & Procedures Healthy Families Response Form Identifying Healthy Families in CMS & IS CalWORKs Eligibility Enki Health & Research Systems, Inc. Client Financial services manual table of Contents 2 CalWORKs Aid Code Information Identifying CalWORKs in IS & CMS CalWORKs Notice of Change Procedures CalWORKs Notice of Change Form (CFS-007) Proofs of CalWORKs Eligibility / Termination Clinical Assessment Referral CalWORKs Treatment / services Verification CalWORKs Eligibility Worker / Gain services Worker CalWORKs Supportive services Enrollment Termination Notice Service Provider Cancellation / Stop Notice CalWORKs Supportive services Provider Referral CalWORKs Supportive Service Results Minor Consent Medi-Cal Full Cost Client Fees Policy & Procedures Full Cost Notice to Client Form Medi-Cal SOC or FC Form Procedures Sample of Medi-Cal SOC or FC Slip Identifying Full Cost clients in IS & CMS Billing Dept.

3 Full Cost Notification & Important Notice Procedures Corporate Notification of Full Cost Form (CFS 005) Site Notification of Full Cost (CFS 006) o Important Notice to Client (sent with FC statement eng/span)(CFS 004) Zero (0) UMDAP clients Identifying Zero(0) UMDAP clients in IS & CMS LACDMH-RMD Financial Screening manual Completing the Computerized PFI Policy & Procedures Computerized PFI Calculating Gross Income for PFI Policy & Procedures Sample Pay Check Stubs Financial Packets Policy & Procedures Medicare Procedures With or Without any Other Payor Sources Copy of Medicare Identification Card Lifetime Medicare Authorization and Assignment of Benefits (English & Spanish) Completing the Medicare Eligibility Inquiry Form Identifying Medicare Only clients in IS & CMS Plans and Medi-Cal with $ 0 UMDAP Policy & Procedures Section Two: Miscellaneous Client Financial services Procedures and Forms List of Required Proofs for Plans and HF Policy & Procedures Proof of AB3632 AB3632 Consent Form Proof of Family Preservation Proof of Specialized Foster Care Victims of Crime Policy & Procedures Refreshing / Updating Plan in E-COERS Policy & Procedures Indigent Client Policy & Procedures Policy & Procedures Regarding Letters of Support Client Financial or Medi-Cal SOC Client Financial Agreement Forms Procedures Enki Health & Research Systems, Inc.

4 Client Financial services manual table of Contents 3 Client Financial Obligation Forms (English/Spanish) Medi-Cal SOC Financial Obligation Forms (English/Spanish) Third Party Insurance Policy & Procedures Third Party Insurance Verification Form Annual Insurance Authorization & Assignment of Benefits Form (English/Spanish) Proof of 3rd Party Insurance Card Therapeutic Fee Adjustments Policy & Procedure Therapeutic Fee Adjustments Request Form (English/Spanish) UMDAP Reports Policy & Procedures UMDAP Date Expiration Report (E-COERS) clients Needing UMDAP Re-evaluation/ Financial Screening (IS150) UMDAP Card Policy and Procedure Sample UMDAP Card Referral to DPSS Policy & Procedure Referral Letters to DPSS/SSA (English/Spanish) Internal Memo of Referral Notice of Change ( Financial Coverage or Change of Plans Policy & Procedure) Notice of Change Form Information Request (Missing Proofs) Procedure clients Reminder Notice (First Notice, English/Spanish) Letter to SFPR (Second Notice, 30 Days Later) Re UMDAP (Re-Evaluation) Financial Screening Process Financial Re-Evaluation Letter (English/Spanish)

5 Client Correction Form Procedures Client Correction Form Admission/Readmission Log Policy & Procedure New Admission / Readmissions Daily Log Defer Client Billing Request Procedure Defer Client Billing Request Form Courtesy Write -Off Policy & Procedures for Discharge clients Request Form Courtesy Write-Off Request Form Colored Coordinated Monthly File Information Reference Notes for Financial File Process Reference Note Form Procedure for Receipt of Payments Deposit Breakdown Form Revenue Report Form Payment Record Procedures Client Payment Record Form Client Billing Statement Policy & Procedures Sample Copy of Client Billing Statement 60/90 Day No Payment Memo Procedures 60 Day Memo to Clinic Manager (CFS029) 90 Day Memo to Clinic Manager (CFS030) 90 Day Letter to Client (English/Spanish) (CFS031) Laboratory Statement Procedures Interoffice Memo Regarding Lab Statement Sample Lab Bill Medical Records Request Procedures Memo Requesting Records from Corporate Billing Department (From Medicare or 3rd party) Enki Health & Research Systems, Inc.

6 Client Financial services manual table of Contents 4 Policy & Procedure for Discharging clients Error Correction Report Summary Service Types Negotiated Rates Per Minute 09/10