title goes here · streamline healthcare solutions •contract awarded june, 2016 •based in...

PartnerSolutions.org

SmartCareMCO Implementation

Andy Gray, Database Administrator/Analyst

April 11, 2017

PartnerSolutions Health Informatics Forum

PartnerSolutions.orgA department of StarkMHAR

Presentation Structure

• Brief History & Overview of PartnerSolutions

• RFP Process for MACSIS Replacement

• High-level Implementation Philosophy and Timelines

• Next Steps

• Q&A

http://www.starkmhrsb.org/


What is PartnerSolutions?What we do

A department of Stark County Mental Health & Addiction Recovery, PartnerSolutions operates the administrative services organization for twelve

Mental Health and Recovery boards in Ohio.

Data Analytics (MACSIS/SmartCare)

Health Informatics (NextGen)

Homeless Navigation (Homeless Hotline/HMIS)



PartnerSolutions Ashland, Ashtabula, Belmont, Columbiana, Hancock, Harrison, Holmes, Jefferson, Mahoning, Monroe, Portage, Stark, Trumbull, Union, and Wayne Counties

SFY 2016 Volume• 67 agencies• 433,000 claims• $24 million • 22,000 members

served• 4,800 837s • 1.7 Million citizens



RFP Process for MACSIS Replacement• Began September, 2014• Comprehensive 221-point scoring system for finalist vendors

• Organizational Strength• Replacement of Existing Functionality• New Functionality• Implementation• Long-term Future

• 5-year TCO• Licensing/Hosting• Increased Staffing• Implementation

• Contract awarded to vendor with best “Score/TCO” (value per dollar)

• Contract signed June, 2016



Streamline Healthcare Solutions

• Contract Awarded June, 2016• Based in Kalamazoo, Michigan, with offices in

Chicago and Bangalore, India• 2 Product lines; MCO and EHR (both web-based)• Established in 2003 by co-owners David Ryland and

Javed Husain• 148 Employees• 48 Customers in 16 States

• Southwestern Michigan Behavioral Health an MCO/Payer very similar to PartnerSolutions



SmartCareMCO ImplementationBegan September, 2016

Fundamental Concepts:1) Mimic Medicaid unless there is a compelling reason not to2) Mimic MACSIS unless there is a compelling reason not to3) Make the system work as well and as easily as possible for everyone

When in doubt, choose the more secure, forward-thinking, less arduous option that introduces the least amount of change for SFY 2018.



Data Migration• Clients with claims in either MACSIS or MITS with

dates of service January 1, 2016 to present will be migrated on June 28, 2017• Basic demographics

• Medicaid/Board eligibility

• Copayment responsibility

• The “linkage” that needs to exist prior to claims paying

• New eligibility spans for all clients begin on July 1, 2017

• More on later slides about the details



What MACSIS (and we) did and didn’t do well

Weaknesses To Improve• Mandatory lag between EDI and creation of 835s• No data integrity checking (race, family size, language)• Authorization module was never purchased• Coordination of Benefits• Inconsistent collection of family size/income/client copayments• No definitive policy stance on arbitration of residency disputes• Poor maintenance of email contact lists• No periodic client disenrollment (there are 4 ways to get out of MACSIS)• Poor enforcement of periodic demographics updates• No fund accounting• Capping contracts is difficult• No clinical components• Poor integration with PCS (State Hospital) Information System (now Avatar)



What MACSIS (and we) did and didn’t do well

Strengths To Maintain• Stability• Passed security audits• Allowed claims to be routed to payer based on residency*• Data entry is easy and fast• Very difficult to create a duplicate client• Duplicate claims checking with both Medicaid and other Boards is “baked

in” and easy



What isn’t changing for providers• UCI numbers become SmartCare “Client ID”• UPI numbers will be part of the “Site ID” in SmartCare• Our reporting (other than Pseudoclients)• Out-of-County Held Claims• Use of our website to retrieve reports and communicate non-837/835 PHI• Frequency of payment processing (once per week)• Enrollment (both fax and NextGen process, all Counties)• Board requirements not otherwise specified in SFY 2018 contracts• Modifiers must be in the proper position (this is not a change from MACSIS

but is a difference with Medicaid)**• Back-end Eligibility and Claims interface with Medicaid/Retros



What is changing (Phase One) July 1• Construction and naming convention of 837s (see the Companion Guide)• Where/how to send 837s (outside today’s scope; attend a training!)• Provider Access

• New Process for obtaining logins to SmartCare will require supervisor sign-off

• Some 3rd modifiers currently in use are being reassigned by Medicaid• 835 files are created and downloaded by provider staff

• No enforceable naming convention• Payments will be tied to SmartCare “check number”

• Capping Contracts is now possible• Two new demographics data elements (Stark System of Care Grant)• All PseudoClient UCIs

• No shared system between Non-PartnerSolutions Boards (Summit, etc)• Multiple enrollment processes

• No cross-platform Master Patient Index

• Up-to-date Residency information across Counties now even more vital for prompt payment



What isn’t changing yet (Phase Two)

• Providers logging in to request enrollments/changes

• Regional Meetings after go-live and beyond



What isn’t known yet but is in progress

• Individual Practitioner NPI & Related Data Flow

• Specifics related to Pseudo-clients

• Shadow Billing

• Whether OS Ticket will be used for SmartCare

• Use of Prior Authorizations



The Future (Phase Three and Beyond)

• Enhancements in Production Reporting• We do still produce new reports… when not writing and

analyzing RFPs and implementing new systems for literally years at a time…

• Streamline “Customer-driven Development”• We have flexibility & control MACSIS could not offer

• What do the customers want in the system?• The RFI process?

• Integration with other data sources for HEDIS Measures?

• Other…?



Claims Testing• 837 “alpha” testing (MACSIS logic) began January 26, 2017• Companion Guide (MACSIS logic) distributed to all on March

17, 2017

• 2 Agencies Passed Files• 0 Agencies Passed Every Combination of service/modifier• 6 Providers in testing• 61 Providers not begun yet

• Companion Guide (BH Redesign logic) distribution: TBD



Steps to MACSIS-logic Compliance in EPM

• Being developed: All of this is subject to change• Payer

• Copy the MACSIS Payer for MACSIS-logic testing

• NEIC/Payer Number = “PartnerSolutions” (line 4 in Table 1)

• ERA Payer Number = “341240178” (line 5 in Table 1)

• Submitter Profile• Copy MACSIS Submitter Profile for MACSIS-logic testing

• Change default file name (see Companion Guide)

• Application Sender Code (GS02) = 5-digit UPI

• Primary ID (only if above is checked) = [TBD]

• Alterations to Remittance Profile Library: TBD

• Do not use the MACSIS Utility for SmartCare files



Individual Practitioner NPIs• System development in SmartCare to allow for

different rates by level of credential of the rendering (or supervising, etc, as appropriate) provider is complete

• We will collect Practitioner NPI and related data from providers until we receive it from Medicaid (and permanently if we don’t receive it from Medicaid)*

• This data is required to allow mapping between Practitioner NPI and the various licensure groups



SFY 2018 and MACSIS/SmartCare• Transition from MACSIS to SmartCare will be service date-

based• SFY 2017 Service Dates will deny in SmartCare• SFY 2018 Service Dates will deny in MACSIS

• PartnerSolutions/Boards will maintain enrollment changes as appropriate in both systems until MACSIS is shut down

• Submit SFY 2017 claims to MACSIS as soon as possible after June services are provided

• MACSIS will not be available to process claims (including Medicaid Retros) after January 1, 2018.



Q&A Time

It’s a lot to cover. Hopefully there is ample time for questions. If not…



Contact us

Andy Gray [email protected] 330-430-3961

Cindy Hamrick [email protected] 330-430-3966

Mark Kress [email protected] 330-430-3991

Jody McCluggage [email protected] 330-430-3990

Claim File Testing [email protected] N/A


mailto:[email protected]





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