These fields display information about the entity the case concerns. None of these fields can be edited.

The fields displayed are determined by the entity type:

ND MMIS generated number assigned when a case record is initially created. It cannot be modified.

The type of organization, institution, or individual.

Example: Provider

Unique identifier used for a provider of healthcare services.

Format: Up to 15 alphanumeric characters

Unique code that indicates the type of provider ID entered.

Examples: DEA, NPI, SSN/EIN

Unique identifier of the payee/payer.

The enrollment status of the provider.

The name of the provider that the case is about.

Examples: Assumption Community Hospital, John Smith, etc.

The provider's certified medical specialty. The provider specialty is based on the Level Ill Area of Specialization of the Taxonomy Code Set.

Examples: Allergy, Blood Banking, Dentistry, Dermatology, Podiatry

The provider classification. Based on the Level I Provider Type of the Taxonomy Code Set.

Examples: Dental, Pharmacy, Hospital, Vision, Physician

A code to identify type of alternate identifier.

Examples: SSN, ME (Medicaid), BC (Basic Care)

An additional unique identifier being used for a provider.

The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

ND MMIS generated number assigned when a case record is initially created. It cannot be modified.

ND MMIS generated number assigned when a case record is initially created. It cannot be modified.

One of the following identifiers:

• The alternative ID assigned to the provider during enrollment.
• Unique identifier for the contact management entity to identify the un-enrolled entities.

The type of organization, institution, or individual.

Example: Un-enrolled Provider

The status of the provider's enrollment application.

The name of the un-enrolled provider.

Examples: Assumption Community Hospital, John Smith, etc.

The provider's certified medical specialty. The provider specialty is based on the Level Ill Area of Specialization of the Taxonomy Code Set.

Examples: Allergy, Blood Banking, Dentistry, Dermatology, Podiatry

The provider classification. Based on the Level I Provider Type of the Taxonomy Code Set.

Examples: Dental, Pharmacy, Hospital, Vision, Physician

ND MMIS generated number assigned when a case record is initially created. It cannot be modified.

The type of organization, institution, or individual.

Example: Member

A unique identifier assigned to a member.

The kind of ID entered in the Entity ID field.

Examples: Medicaid ID, Member MMIS ID, SSN, etc.

Social Security Number.

A nine-digit number assigned by the Federal government, usually assigned at the time of birth and used for tax purposes.

Format: NNN-NN-NNNN or NNNNNNNNN

Example: 123-45-6789

Note: This field cannot contain all zeros.

The e-mail address of the user.

Example: ijones@myemail.com

The member's type of eligibility coverage under Medicaid.

Example: BCCP - Breast/Cervical Cancer Program

The regional office where members go to get information. For example, picking up or signing documents.

The date the person was born; the person's date of birth.

Format: MM/DD/YYYY

Example: 05/23/1935

A previous name that the member may have used. This could be the person's former married name if they are divorced or their single name if they are now married.

A code to identify type of alternate identifier.

Examples: SSN, ME (Medicaid), BC (Basic Care)

An additional unique identifier for a member.

The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

ND MMIS generated number assigned when a case record is initially created. It cannot be modified.

The type of organization, institution, or individual.

Example: Un-enrolled Member

Unique identifier for the contact management entity to identify the un-enrolled entities.

Social Security Number.

A nine-digit number assigned by the Federal government, usually assigned at the time of birth and used for tax purposes.

Format: NNN-NN-NNNN or NNNNNNNNN

Example: 123-45-6789

Note: This field cannot contain all zeros.

The e-mail address of the person.

Example: ijones@myemail.com

The gender of a person, usually male or female. In some cases, the gender may also be unknown.

The date the person was born; the person's date of birth.

Format: MM/DD/YYYY

Example: 05/23/1935

ND MMIS generated number assigned when a case record is initially created. It cannot be modified.

The type of organization, institution, or individual.

Example: TPL Carrier

The unique identifier of the organization responsible for the third-party coverage.

The descriptive name of the organization responsible for the third-party coverage.

ND MMIS generated number assigned when a case record is initially created. It cannot be modified.

The type of organization, institution, or individual.

Example: TPL Policyholder

ND MMIS generated number assigned when a case record is initially created. It cannot be modified.

The type of organization, institution, or individual.

Example: Trading Partner

The kind of trading partner. Automatically displayed.

The type of organization, institution, or individual.

Examples: Provider, Member, Attorney, TPL Carrier

Unique identifier for the contact management entity to identify the un-enrolled entities.

The name of the organization, institution, or individual.

The current step in the processing of the case.

User who initially created the case record.

The user to whom the case record is currently assigned.

Date the case record was created. This date is automatically assigned by ND MMIS when the user initially saves the case record.

Format: MM/DD/YYYY

The number of days the case has been open, or the number of days it took to close the case, depending on the case's status.

The reporting unit of the user who is currently assigned the case record (the Assigned To user).

Examples: State, Medical Services

The business unit of the user who is currently assigned the case record.

Example: Level of Care Determination

The work unit of the user who is currently assigned the case.

Examples:Customer Service, Support Staff

Indicates what a case is about.

Examples: Provider Appeal, Level of Care Determination

The stage of the case. The status changes depending on the case type and where it is in the resolution process.

The level of importance of the inquiry or request.

Examples: High, Medium, or Low

The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

Indicates if a supervisor is required to review and approve a case before it is closed.

If you select the Provider Appeal Case Type, to display the Provider Add Appeal page and add an appeal, click Continue. You are directed to the Provider Appeals Page

If you select the Member Appeal Case Type, to display the Member Add Appeal page and add an appeal, click Continue. You are directed to theMember Add Appeal Page.

Case Type Specific Fields

This section of detail fields changes based upon the Case Type you select.

Indicates whether the level of care determination case is new, under review, or a reapplication.

Examples: New, Reapplication

The date that the level of care determination is active.

Format: MM/DD/YYYY

Default: Start Date plus 90 days

These additional fields are displayed if the case type indicates LTC Level of Care Determination

Indicator specifying that a review is required.

The date the review starts.

Format: MM/DD/YYYY

The date the review is scheduled to end.

Format: MM/DD/YYYY

The date information was last received for review.

Format: MM/DD/YYYY

These fields provide information on the decisions reached for all types of Level of Care Determination cases.

The date the decision was made on the case.

Format: MM/DD/YYYY

The level of care needed to support the decision.

Additional Case Details Fields

Custom fields to record additional case details may be displayed based on the case type. The following are some typical custom fields.

Indicator specifying whether the case has been sent to the regional office.

The date that the case file was sent to the supervisor.

Format: MM/DD/YYYY

Indicates the status of the case findings.

Example: Pending

Indicator specifying whether other insurance is involved in the case.

The location site where this case records are located.

The current state or action taken in regards to the case.

Additional Case Entities Fields

To add an additional entity to the case, use the Inquiring About Case Entity Search page. To delete an entity, in the Additional Case Entity table, click the appropriate row and, on the Additional Case Entities action bar, click Delete. None of these fields can be edited.

The unique identifier used for an entity in ND MMIS about which healthcare information needs to be maintained.

Note: Entity ID depends on Entity Type. For example, a Provider Entity Type requires a Provider ID.

The name of the organization, institution, or individual.

The kind of record associated.

Examples: SA, TCN, TPL Recovery Case, External Claim, Miscellaneous

The unique identifier for the record.

When editing, links to the appropriate page containing specific details for this record. For example, if you click a claim transaction control number, the Claims Inquiry page is displayed.

The status of the record.

Examples: Pending, Open, Paid

The beginning date associated with the record. Displayed only in the table.

Examples: The first date of service, the date of the transaction, the start date of the recovery case

To add a routing assignment, click Add Routing Assignment. To edit, in the Routing table, click the appropriate row.

A check mark indicates the record displays in your watchlist for monitoring.

The filter associated with the routing.

Examples: Business Unit, Work Units, Users.

All previously created case and correspondence records created within a pre-determined time period for the entity ID are displayed in the Existing Case Records and Existing Correspondence Records tables.

To manually search for other records, in either the Case or Correspondence section, click Search. The fields used to search are described in the Case Record Search and Correspondence Record Search table later in this topic. The record that matches your search filters is displayed in the search results table. In the search results table, click Link to add an association for that record to the current case.

Other cases and CRs already associated with this case are displayed in the Case Records Associated with this Case and Correspondence Records Associated with this Case tables. To view details or detach a record, click the appropriate row.

Indicates the CR is linked to the current case record.

Case Fields

Status of the case record.

Examples: Open, Closed, Denied, Pending, Withdrawn, etc.

Case Regarding/Additional Case Entities Fields

Use the Case Regarding panel if you want to search for the entity about whom the case was opened.

Use the Additional Case Entities panel to search for an entity that is included in the Additional Case Entities table of a case. This is another entity associated with the case that is different from the entity in the Case Regarding fields.

The type of organization, institution, or individual.

Examples: Provider, Member, Attorney, TPL Carrier

An entity's unique identifier such as a SSN, Medicaid ID, Provider ID, Member ID, etc

Note: Entity ID depends on Entity Type. For example, a Provider Entity Type requires a Provider ID.

ND MMIS generated number assigned when a case record is initially created. It cannot be modified.

The title of the case.

User who initially created the case record.

The user to whom the case record is currently assigned.

Status of the case.

The date on which the status was changed. This date is automatically generated.

The level of importance of the inquiry or request.

Examples: High, Medium, or Low

The reporting unit of the user who is currently assigned the case record (the Assigned To user).

Examples: State, Medical Services

The business unit of the user who is currently assigned the case record.

Example: Level of Care Determination

Indicates if the search includes only records that have or do not have existing responses/letters.

Correspondence For/Inquiring About ID Fields

Use the Correspondence For panel if you want to search for an entity whose information appears in the Correspondence For panel of the CR. This is the entity to whom or from whom the communication occurs.

Use the Inquiring About ID panel to search for the entity whose information appears in the Inquiring About ID panel of the CR. This is the entity the communication is about, if it is different from the entity in the Correspondence For fields.

The type of organization, institution, or individual.

Examples: Provider, Member, Attorney, TPL Carrier

The kind of ID entered in the Entity ID field.

Examples: Medicaid ID, Member MMIS ID, SSN, etc.

The unique identifier used for an entity in ND MMIS about which healthcare information needs to be maintained.

Note: Entity ID depends on Entity Type. For example, a Provider Entity Type requires a Provider ID.

The current status of the CR.

The type of category for the CR.

The level of importance of the inquiry or request.

Examples: High, Medium, or Low

The date of that the status changed on the CR.

Format: MM/DD/YYYY

Unique code that indicates the type of provider ID entered.

Examples: DEA, NPI, SSN/EIN

The reason or subject of the correspondence call.

The reporting unit of the user (Assigned To user) who is currently assigned the CR.

Examples: State, Medical Services

The method or how the correspondence was triggered.

Examples: Email, In-Person, Phone, Fax

Identifies how the correspondence was resolved.

Examples: QR-QuestnResld, C-Closed, LT-LetterSent

The business unit of the user (Assigned To user) who is currently assigned the CR.

Example: Level of Care Determination

The beginning date range indicating when a CR was created. The Created From date must be earlier than the Created To date.

Format: MM/DD/YYYY

The user to whom the CR is currently assigned.

The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

The work unit of the user who is currently assigned the CR.

The ending date range indicating when a CR was created.

Format: MM/DD/YYYY

To add an attachment,

• To attach documents from a local computer, click Add Attachments and in the Attachment panel, click Browse.
• To search and attach documents from the Electronic Document Management System (EDMS), click Search Document Repository.

To edit, in the Attachments table, click the appropriate row. To remove the association to an attachment, on the Attachment action bar, click Detach. The document remains in the Attachment table, but the hyperlink is removed.

The name of the attached document. When adding, it is automatically displayed after the document is selected.

To edit, in the Letters & Responses table, click the appropriate row.

To create a letter, click Create Letter.

To view the letter request, click View Letter Request.

To view an image of the letter in the EDMS, click View Letter.

Note: The View Letter option is only available if the letter request status is Generated.

The name of the template used to create a letter or response.

The current status of the letter.

Examples: New, In Review, Approved, Generated, Rejected, Deleted

Indicates that a supervisor needs to review and approve the letter request.

Note: This field is automatically selected on the Letter Generation Request page if the pre-defined template has Supervisor Approval Required selected on the Maintain Templates page.

To add a new case event, click Add Case Events. To edit, click the appropriate row in table. To delete a case event, in the Case Event action bar, click Delete.

To add a letter or response, click Create Letter.

The type or kind of case event

Examples: Appointment, Reminder, etc.

Diagnosis associated with this case.

This field is available only if SRT Appt event type.

Exam test associated with this case.

This field is available only if SRT Appt event type.

The case steps are predefined based on the type of case. To add a new case step, click Add Case Steps. To edit, click the appropriate row in the table.

If you came to this page from the Notes link on a record, to add a new note, on the Notes action bar, click Add New Note.

Existing notes are listed in the Notes History table. To view the complete text of a note, click the appropriate row.

To print notes, in the Notes History table, select the notes to be printed, and then on the Notes action bar, click Print Selected.

The complete text of either the most recent note created or the note selected in the Notes History table.

Notes History Fields

To view a previous note, click the appropriate row. To print all notes, in the table header, click the check box. To select a note to be printed, on the appropriate row, click the check box.

Check box that indicates if the note is to be printed. If the check box in the Notes History table header is selected, all notes are selected.

Note text.

When you select a note to view, the note text in the highlighted row is displayed in the Current Note field.

The business name associated with the note.

Displayed in the Notes History table only after searching for notes from the Notes option on the Contact Management menu.

The business purpose for which the note was written. The codes displayed are specific to the job responsibilities of the user entering the note.

Counter that indicates how many characters you have available when entering text. It decreases by one for each character entered and increases when a character is deleted.

This field is displayed when adding a note.

Filters Fields

To display filter fields, on the Notes action bar, click Filter. To activate the filter, on the Notes action bar, click Apply Filter. To clear all filter information and complete filter options again, click Reset.

Beginning date range for filtering notes.

Format: MM/DD/YYYY

End date range for filtering notes.

Format: MM/DD/YYYY