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Health & Human Services Medicaid Administrative Claiming (MAC) Overview

Learn about the purpose and benefits of MAC, the process, participation requirements, financial reporting, and important dates. Contact information provided.

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Health & Human Services Medicaid Administrative Claiming (MAC) Overview

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  1. Welcome to the Health & Human Services Medicaid Administrative Claiming (MAC) Overview

  2. The Purpose of MAC • To provide public Mental Health and Idividuals with Developmental Disabilities (MH-IDD) programs the opportunity to submit reimbursement claims for administrative activities that support the Medicaid program such as: • Medicaid Outreach • Medicaid Referral, Coordination, and Monitoring • Medicaid Transportation and Translation • Medicaid Provider Relations

  3. The Benefits of MAC • Generate Revenue from MAC claim submission • Dedicated to the provision of health services • May be used to enhance services at the MH-IDD program • by improving and/or expand the level and quality of health/medical and Medicaid services provided to clients within the program.

  4. Participant List Participant Identification Random Moment Time Study MAC Financial Data Collection MAC Claim Calculation Determine who performs MAC activities Determine how much reimbursable activity is performed Determine actual costs associated with these activities Apply reimbursement rates (TS, MER, IDCR) to calculate a claim MAC Process

  5. MAC PARTICIPATION REQUIREMENTS • An Intergovernmental Cooperation Agreement must be filed and executed with HHSC in order to enter financial expenditure information. • Required RMTS participation must be satisfied for the quarter in which the claim is filed. • Appropriate financial information must be collected, entered and certified in order to calculate a claim. • The claim must signed by a entities employee with signature authority, notarized, and submitted to HHSC for payment. Note: Copies of all signed documents and financial statements must be kept in an Audit Documentation File

  6. MAC Financial Contact Responsibilities • Serve as financial liaison between HHSC & Fairbanks LLC • Must attend MAC Financial Training at a minimum annually • Enter, verify and certify the MAC financial data on the system • Certify, notarize and submit quarterly MAC financial reports • Maintain financial documentation and supporting materials • Must be listed as the primary MAC Financial Contact • Trained Financial Contacts must maintain the accuracy of ALL Contacts in the cost reporting system

  7. Participant List Reportable Costs The public entity reports eligible time study participants at the beginning of each quarter via the“Participant List” • Time Study Positions left off the Participant List are not eligible to have costs reported during the financial reporting process for that quarter unless the position is a clerical position. • All positions listed on the Participant List must have costs entered • These include federally funded positions • Costs reported are “position-specific” not “person-specific.” • Substitutes - Individual replacing a provider on leave • Direct replacement - Individual hired to fill a vacant position

  8. Detailed Worksheet Psychologists and Interns Bob Employee Joe Employee Mary Contract Staff Category Summary Registered Nurse (RN) Salaries 30,000 Benefits 6,000 Purchased Svcs. 8,000 Functional Reporting • There are two options to enter financial data: • Participant Detail • Detailed basis by individual position • Group Summary • Provider category summary • Categories as entered on the participant list • If your entities enters at this level, they must keep the detail by position/individual in the audit documentation file.

  9. MAC Financial Reporting • MAC financial quarters will not be opened unless the following requirement are met: • Active contract with HHSC • Appropriate MAC & RMTS training for the FFY • RMTS Requirements are met • If you are unable to access the quarter, please contact the MAC team via email at: MAC@hhsc.state.tx.us.

  10. Important Dates for MAC Claim Submission Event Description Open Date Close Date 1st Quarter MAC Financials 02/18/2014 04/04/2014 2nd Quarter MAC Financials 05/27/2014 07/11/2014 3rd Quarter MAC Financials 08/18/2014 10/03/2014 4th Quarter MAC Financials 11/24/2014 1/09/2015 All important information, notices, claim due dates, etc can be found on the following website: • http://www.hhsc.state.tx.us/rad/mac/mhmr-mac.shtml But also look on the Fairbanks home page for updates and all the same information

  11. HHSC has moved!!! Regular Mail (Including certified) ATTN: Serena Holster HHSC Rate Analysis / Actuarial Analysis Mail Code H-400 P.O. Box 149030 Austin, TX 78714-9030 Overnight Mail: ATTN: Serena Holster HHSC Rate Analysis / Actuarial Analysis Brown-Heatly Building Mail Code H-400 4900 North Lamar Austin, TX 78751-2399

  12. Contacts Medicaid Administrative Claiming – (512) 462-6200 – MAC@hhsc.state.tx.us Yvonne Moorad - Team Lead Serena Holster Cost Report System & Website Questions – info@fairbanksllc.com Fairbanks Hotline: (888) 321-1225 Websites: Medicaid Administrative Claiming http://www.hhsc.state.tx.us/rad/mac/mhmr-mac.shtml Random Moment Time Study http://www.hhsc.state.tx.us/rad/time-study/ts-mhmr.shtml

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