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S t u d e n t S e rv i c es a n d
M e d i ca i d M a na g e r
How To. . .
2
In (SM)
V 9.0
GG Consulting, LLC
GG
888-442-6751
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Student Services and Medicaid Manager (SM)2
Table of Contents
INTRODUCTION ......................................................................................................................................................... 5
Definitions:...................................................................................................................................................... 5
SECTION 1. PROVIDER HOW to… in (SM)2 ...................................................................................... 6
Logging into (SM)2 ....................................................................................................................................................... 6
Create a Schedule .......................................................................................................................................................... 7
Schedule Multiple Dates for a Session ........................................................................................................................... 9
Create a Ticket for a Completed Session through SCHEDULE..................................................................................... 11
Delete a Student from a Session in the Schedule .......................................................................................................... 14
Create a Ticket for a Completed Session through SERVICES....................................................................................... 16
Use Additional Dates................................................................................................................................................... 18
Add a Referring Provider ............................................................................................................................................. 20
Add a Diagnosis Code ................................................................................................................................................. 22
Print the Monthly Claims Report ................................................................................................................................. 25
SECTION 2. ADMINISTRATIVE HOW TO. . . FUNCTIONS IN (SM)2............................................ 27
Log into (SM)2............................................................................................................................................................. 28
Assign Staff Access (ALL) .......................................................................................................................................... 29
Import Students from SEM into (SM)2 (ALL) .............................................................................................................. 37
Identify Billable Staff for Medicaid ............................................................................................................................. 40
Assign Student Services through the Staff Assignments Wizard (M) ............................................................................ 42
Assign Diagnoses .......................................................................................................................................... 43
Assign Referring Providers ............................................................................................................................ 43
Assign Bus Routes ......................................................................................................................................... 43
Understanding the Student Records Screen .................................................................................................................. 48
Preview History ............................................................................................................................................. 49
Scheduled Services ........................................................................................................................................ 50
Demographics................................................................................................................................................ 51
Enrollment..................................................................................................................................................... 52
Parent Data .................................................................................................................................................... 53
Physician Approvals/Referring Providers ....................................................................................................... 54
Diagnoses ...................................................................................................................................................... 55
Transportation ............................................................................................................................................... 56
Staff Assignments .......................................................................................................................................... 57
Eligibility ...................................................................................................................................................... 58
Understand the Maintenance screen ............................................................................................................................. 59
1. Update Student Demographics ................................................................................................................... 59
2. Change Student ID ..................................................................................................................................... 60
3. Delete Student from (SM)2 ........................................................................................................................ 60
4. Update Medicaid IDs in Special Education Manager................................................................................... 61
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5. Parental Consent Tracker ........................................................................................................................... 61
6. Beginning of Year Preparation ................................................................................................................... 62
7. Year-End Maintenance............................................................................................................................... 62
8. Backup ...................................................................................................................................................... 62
9. Staff Assignments ...................................................................................................................................... 63
10. Assign Diagnoses ..................................................................................................................................... 66
11. Assign Referring Providers....................................................................................................................... 68
12. Assign Students to Bus Routes ................................................................................................................. 69
13. Pop-up Editor........................................................................................................................................... 70
14. Edit Diagnosis Defaults ............................................................................................................................ 71
15. Remove Student Assignments .................................................................................................................. 72
16. Staff Positions Reimbursement Defaults .................................................................................................. 72
17. Staff Access and Reimbursement List ....................................................................................................... 72
18. Enter/Edit Medicaid Rates ........................................................................................................................ 73
19. Set School Calendars................................................................................................................................ 74
20. Re-parse Transportation Claim Responses ................................................................................................ 75
21. Reset Denied Transportation Claims for Resubmittal ................................................................................ 75
22. Update “TMHP No Response” Claims ..................................................................................................... 75
23. Compact/Repair Databases ....................................................................................................................... 75
20. IEP Ratios................................................................................................................................................ 75
25. Right to Provider Letter Tracking ............................................................................................................. 75
Transportation ............................................................................................................................................................. 76
Create Bus Routes in Options......................................................................................................................... 77
Enter Rides in the Transportation Log ............................................................................................................ 78
Enter Personal Care On the Bus ..................................................................................................................... 79
Enter Individual Rides ................................................................................................................................... 80
Edit Transportation Log Entries ..................................................................................................................... 82
Create Transportation ‘Tickets’ ...................................................................................................................... 83
SECTION 3. MEDICAID REIMBURSEMENT .................................................................................. 84
The Medicaid Billing Process......................................................................................................................... 84
Assistance with Eligibility and Claims ......................................................................................................................... 85
Medicaid Terminology ................................................................................................................................................ 85
Identify Medicaid Eligibility in (SM)2.......................................................................................................................... 86
Steps to Take Before Creating a Medicaid Claim ......................................................................................................... 88
Create a Medicaid Claim ............................................................................................................................................. 89
Review/Edit Claims..................................................................................................................................................... 91
Claim Status Descriptions .............................................................................................................................. 91
Resubmitting Claims...................................................................................................................................... 91
Submit Files to TMHP................................................................................................................................................. 93
Retrieve Files from TMHP .......................................................................................................................................... 95
Parse Files Received from TMHP ................................................................................................................................ 98
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SECTION 4. OPTIONS SCREEN ....................................................................................................... 99
General Tab ................................................................................................................................................................ 99
Billing Providers Tab ................................................................................................................................................ 100
Referring Providers Tab ............................................................................................................................................ 101
TMHP Data Tab ........................................................................................................................................................ 102
TMHP File Paths Tab ................................................................................................................................................ 102
Connection Setup Tab ............................................................................................................................................... 103
Spell Check Tab ........................................................................................................................................................ 103
Bus Routes Tab ......................................................................................................................................................... 103
Calculate the IEP Ratio for the SHARS Cost Report .................................................................................................. 104
SECTION 5. REPORTS SECTION ................................................................................................... 105
List of Reports in (SM)2 ............................................................................................................................................ 105
Report Criteria .......................................................................................................................................................... 106
Schedule Grid Report ................................................................................................................................................ 107
Scheduled Services by Staff Report ........................................................................................................................... 107
Scheduled Services by Student Report ....................................................................................................................... 107
Transportation Report ................................................................................................................................................ 108
The Parental Consent Report ..................................................................................................................................... 109
Parent Consent Indicted as ‘No’................................................................................................................................. 109
Prescribed Services vs. Scheduled/Rendered Report ................................................................................................... 110
Condensed Eligibility Report ..................................................................................................................................... 111
Eligibility Status Change Report ................................................................................................................................ 111
Medicaid Claims Report ............................................................................................................................................ 112
TMHP Eligibility Report ........................................................................................................................................... 113
Maximum Recommended Units Exceeded/Unavailable.............................................................................................. 114
Medicaid Students w/Tickets Marked No Consent ..................................................................................................... 115
Missing Demographics .............................................................................................................................................. 115
Missing Diagnosis Codes........................................................................................................................................... 116
Missing Procedure Codes .......................................................................................................................................... 116
Missing Referring Providers ...................................................................................................................................... 117
Missing Start and/or End Times ................................................................................................................................. 117
Non-Billable Services Rendered Report ..................................................................................................................... 118
Services by Provider Summary .................................................................................................................................. 118
Services Rendered by Provider Report ....................................................................................................................... 119
Services Rendered by Student Report ........................................................................................................................ 119
Services Rendered by Service Report ......................................................................................................................... 119
Students with Eligible Services and No Tickets Report .............................................................................................. 120
APPENDIX A – BEGINNING OF THE YEAR in (SM)2 .................................................................. 121
List of Tasks ............................................................................................................................................................. 121
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INTRODUCTION
Student Services and Medicaid Manager (SM)2 is designed to assist Special Education Manager
(SEM) users plan and monitor services prescribed for the students in special education. This module
will allow you to track services provided and compare them with those prescribed by the ARD
Committee. Progress can be tracked and easily correlated with the IEP developed in SEM. (SM)2 will
assist with scheduling so that conflicts are avoided. It will also help monitor service provider workload
and parental consent to bill Medicaid.
The two modules, SEM and (SM)2, are designed to work seamlessly with one another. Student, staff
and school information, as well as information from the ARD, is entered through SEM. This data is
then used in (SM)2. Information is updated from SEM automatically on a daily basis.
To help maximize Medicaid reimbursements, Medicaid eligibility is automatically determined for all
students in (SM)2. Claims are then generated based on actual services rendered and student eligibility.
Parental Consent to bill Medicaid is also monitored in (SM)2 using the information from the signature
page of the ARD as well as the SHARS Letter.
This manual is designed to give directions to successfully complete the steps necessary to create
schedules, log services, and run reports in the (SM)2 program. If the program is not being used to bill
Medicaid in your district, you can ignore references to this in the manual.
The format of the manual is to list a common task then provide screenshots of each task on the next few
pages to aid in comprehension. Each screenshot will have numbers/letters corresponding to the
numbered/lettered task in the itemized steps.
Saving Information
When a user logs into (SM)2, they are logged into a temporary database just for them. When they exit
the program, all information they put into (SM)2 is saved to the master database. If for some reason a
user is disconnected from their network before exiting the program, their work may be lost. The SAVE
button at the top of the screen allows the user to save their data periodically to avoid losing large
amounts of data.
Definitions:
a. SEM – Special Education Manager is the program where the ARD and IEP are created.
b. TMHP – Texas Medicaid Health Provider. TMHP oversees Medicaid reimbursements for the
state of Texas. All claims are paid from them.
c. SHARS – School Health and Related Services is a subcategory of the Medicaid program.
d. Provider – Person providing the related service (e.g., Speech Therapist, OT, LSSP).
e. Service – ARD prescribed procedure such as Speech Therapy.
f. (SM)2 Administrator – person who coordinates (SM)2 for the district.
g. Service Record – record of a session entered into (SM)2 by the Provider.
h. Claim – record of Medicaid services provided which is submitted to TMHP for billing.
i. Billing Guidelines – developed by TEA to comply with Medicaid regulations. They list what
services are billable, who can bill for the Service, and the documentation need for each session.
j. Session Notes – following the Billing Guidelines, some Services require that the Provider list the
session activity and related IEP objective.
Please note that all students in this manual from (SM)2 are fictitious and pulled from a random
sampling of the most popular first and last names.
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SECTION 1. PROVIDER HOW to… in (SM)2
How to….
Logging into (SM)2
1.
2.
3.
4.
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Select name from ‘Staff Member Name and enter password.
Click ‘Continue’.
Click ‘OK’.
Double-click on Student Services and Medicaid Manager in the GG Consulting Suite. Note:
If the button is dark blue, contact the district program administrator for (SM)2.
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How to….
Create a Schedule
The scheduler is designed to assist with scheduling services prescribed in the ARD as well as adding in
time into the schedule that is not specific to a particular student.
On the Main Menu click Schedule. The ‘Scheduler’ screen will open.
The appropriate staff member’s name should appear in the first field.
Select the month and year from the corresponding drop down lists.
Select the school for which the general calendar is to be shown.
Double-click on the desired date to open the Daily Planner.
Click next to the time in the lower section of the daily planner that will be the start time for the
session. (Once you select the time, you should see it in read at the top of the screen.)
7. In the entry box at the top of the screen, select the student you would like to schedule for that
session from the dropdown box. If more than one student will be part of this session, select their
name in the next empty box.
8. Select the Procedure to be performed from the list in the dropdown box. Note: If more than one
student is in this session, you should select the Procedure with GRP behind it which indicates
that this is a group session.
9. Select the Location of the service.
10. Select the amount of time that the session will last in Minutes.
1.
2.
3.
4.
5.
6.
You have now successfully scheduled a student for a session or a group of students (if you have entered
more than one student) for a session.
Things to Note:
a. The Scheduler is designed to assist with scheduling services prescribed in the ARD. These services can be identified in
the student history in SEM. In (SM)2 the student history can be previewed on the General Student Information screen in
Student Records.
b. Personal Block – If the time for a session is not for a specific student or group of students, you can put a checkmark in
the Personal Block box and this will be reflected in the section above where the student would have appeared. Examples
might be time reserved for ARDs, doctor’s appointment for the Provider, etc. Note: This box does not appear if students
are already selected for that timeslot.
c. The ‘Start’ and ‘End’ times on the Daily Planner are for the work day. You will get an error if you schedule beyond
these times. ‘Extended’ will appear below the times not within your day for reference when the 24 hour box is checked.
Note: Make sure these times cover your entire workday or you will get an error. You can also display the entire 24 hours
of the day by checking the box ‘24 Hr.’
d. The Time Increment indicator is to have the option to display in 5 minute or 15 minute increments in the Minutes (10)
box.
e. The Notes field is for personal notes for the session and will not be included on the ticket when it is created.
f. On the Scheduler screen where you can see the calendar, you can click the Show Detail box and all sessions scheduled
for you will be filled in on the day they are scheduled for that month.
g. One thing to note about the Scheduler is that this schedule is not set in stone. If a student discontinues with a group, they
can be deleted. If a student arrives late to a session, the time can be edited when the ticket is created. If they come on a
different day, create a session for the time slot they do attend.
h. Do not forget to SAVE periodically to avoid losing any data.
i. Show Group goal and note defaults can be used to select a goal that more than one of the students is working on at the
time of the service. If this box is checked, 2 boxes will appear: a group goal box and group notes box. Whatever is placed
in these boxes will be the goal or notes for each ticket created.
j. For a printout of Today’s Schedule or the schedule for the week, click Print Weekly or Print Today as appropriate.
k. Click the X next to a student’s name to delete that student from a timeslot for that day or future dates if they were
scheduled for Multiple Dates. See next section.
l. The date entered into this field indicates the date of data after this date that the user will see in the system. Nothing
created before this date can be viewed until the date is changed to an earlier date. Default is first day of current year.
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Create a Schedule Screenshots
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How to….
Schedule Multiple Dates for a Session
Multiple dates are set for the same service in the same time slot for all members of the group.
1. On the Daily Planner, place the cursor in the timeslot of the group to be scheduled. a
2. If the inidividual/group is not already scheduled in the slot:
i. add an entry by selecting the student(s).
ii. select the Procedure to be implemented
iii. select the Location.
iv. select the duration of the session in Minutes.
3. Click the ‘Set Multiple Dates’ button to open the Twelve Month Scheduler.
4. Click on the dates to schedule the service (the same time, location and duration of service will be
used). b,c,d,e
5. Click the ‘Schedule Group’ button. e
6. CLOSE when finished.
Things to Note:
a. The students to be scheduled in the group will be listed in the top right of the Multiple Dates screen.
b. Refer to the bottom right of the Multiple Dates screen for a legend of the colored dates. Conflicts will be shown in the
Conflicts box to the right of the screen when a date is selected.
c. The No School (red) dates are put into the schedule by your district contact for (SM)2. If any of these are incorrect, you
can contact that person.
d. To deselect a date, click that date again.
e. Make sure you select ALL dates that you want to include before clicking the Set Multiple Dates button. If you have
selected dates, clicked the button and would like to select more dates, please exit this screen and re-enter the Multiple
Dates screen before selecting additional dates.
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Schedule Multiple Dates Screenshots
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How to….
Create a Ticket for a Completed Session through SCHEDULE
Each time a service has been provided, a “ticket” needs to be created for that session.
1. Open the ‘Schedule’ for the day the service was provided using the calendar.
2. Click on the appropriate time slot in the Daily Planner. The name(s) will appear in the grid at
the top left of the screen.i
3. Click the ‘Ticket’ button to the right of the name of the student for whom the ‘ticket’ is being
created. Each student in a group is clicked separately. a,d,j,n
4. Verify data on ‘Service Data’ tab and make corrections as needed (e.g. start time, end time).e,f
5. Indicate if the service was a consult or is non-billable (consults and non-billables will not result
in claims). Services are indicated as DIRECT by default.b,m
6. If appropriate, click the Goals tab. Select/enter the appropriate goal(s).g
i.
ii.
The goals listed in the drop-down list to the right are from the student’s IEP in SEM.
The goals listed in the drop-down list below the ‘Goals’ field are district-defined goals (added by the (SM)2
contact person in your district).
7. Click the ‘Notes’ tab (for all services except Personal Care. Personal Care should skip to step
8). Enter notes or required Session Notes into the field. c,g
i.
ii.
If you use the IEP writer in SEM, the Objectives associated with that student will be available here.
The ‘Progress’ field can also be used to import the notes from this textbox into the student’s Progress
Report for the objective in SEM. ‘Copy Notes’ will copy from the ‘Notes’ field to the ‘Progress field’.
8. If the ‘ticket’ is for Personal Care Services, click the ‘Personal Care Services’ tab. This tab is
not available for services other than personal care. Complete the Personal Care tab.g
9. If appropriate (e.g. printing individual tickets to record signatures or signature of supervisor is
required), click the ‘Signatures’ tab. Select/enter up to 3 persons who will sign the ‘ticket’.
10. Click ‘Close Ticket’.
11. Repeat steps 3 through 8 for all students who were in attendance in that session.
Things to Note:
a. If there is no diagnosis code for the procedure, a message box will appear in step 3 asking if you want to select a
diagnosis. ALL Medicaid ‘TICKETS’ MUST HAVE AN ASSOCIATED DIAGNOSIS CODE. Go to How
to…Add a Diagnosis Code to learn this step.
b. Unless indicated as Consult or Nonbillable, a service will ALWAYS be billed.
c. Depending on the service, Notes may or may not be required. If they are required, there will be a checkmark next to
Notes Required. You should also refer to the Billing Guidelines for SHARS to make sure you have met all compliance
items when completing notes. Although a service may not need specific Session Notes, all services have a minimum
requirement of including what service was performed during the session.
d. Once a checkmark appears under Created, the ticket has been created. Any changes to the ticket need to be made ON
THE TICKET itself. You can view a created ticket by clicking the ticket button again. If the ticket does not allow a
change, then the ticket has already been included in a Medicaid claim and cannot be edited.
e. The system is programmed to automatically calculate the billable amount of time that the student was served. You have
the ability to change the units. For example, Medicaid only allows 4 hours per day for Psychological Testing. If the
assessment personnel used 5 hours that day, the system will bill Medicaid for 5 hours unless the user changes it to 4.
f. Max Recommended Units is the amount of time that Medicaid will pay for a service. This cannot be changed by the user.
g. ‘Import from Previous Session’ button will copy the goals or notes from the previous ticket onto this ticket.
h. Do not forget to SAVE periodically to avoid losing any data.
i. The Provider can be marked Unavailable for the session or the day by checking the ‘Provider Unavailable’ box.
j. If there is a message about a missing Referring Provider, follow the steps in How To Add a Referring Provider in this
manual. Medicaid requires Referring Providers for Speech Therapy, OT, & PT.
k. Provider Nonbillable – this is checked when the claim is created if the Provider is not billable according to SM2.
l. No Parental Consent - this is checked when the claim is created and the ticket does not have PC on that day. If PC is
updated in SM2, the ticket will be readdressed when the next claim is built for the date range of that ticket.
m. ‘Co-Teach with Personal Care’ will allow this ticket to be billed if a PCS ticket was also created for this time period.
n. If the student did not attend the session, click ‘Not Avail’. Do not click the Ticket button (which creates the ticket).
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Creating Tickets Screenshots
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How to….
Delete a Student from a Session in the Schedule
If a student stops coming to a session for any reason, they can be removed from the schedule for all
dates they have been scheduled for that session.
1. Open the ‘Schedule’.
2. Double click on the first date that the student is to be removed from the schedule to open the
Daily Planner.
3. Click on the X next to the student’s name in the upper left-hand corner where the student(s)
is listed for the session.a,b
4. Click Yes to ‘Delete the Record’.
5. If the student is schedule for multiple dates in the future, a box will come up asking if you
want to delete the student for all future dates. Select the answer that applies.
6. Select Yes to delete for future dates.
7. Select No to delete for this session only.
8. If you selected Yes, another box will come up asking for a date range of the future dates. If
you only want to delete the student for the next month from the schedule, you could just put
the month in the date range. If you want to delete them from all future occurrences in that
time slot, you can leave the date range blank.
9. A confirmation box will come up verifying the date to delete the student. Click Yes to
continue or No to cancel.
10. The student is now deleted from the schedule.
Things to Note:
a. The student should be deleted from the Schedule for that Provider before any campus changes are made in SEM for that
b.
student or the Provider may not be able to see that student.
If the student is not visible on that day check this date to verify that information from that date were downloaded.
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Deleting a Student from the Schedule Screenshots
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How to….
Create a Ticket for a Completed Session through SERVICES
For those who typically do not schedule the services tracked (e.g., those writing reports), services can be
tracked through the Services section of the program.
1. Click ‘Services’ on the Main Menu. The Services screen will open.
2. Select the student for whom a service will be recorded.
3. Your name should be listed as the ‘Service Provider’. If someone else provided the service
and you are documenting the service, change the name to that Provider.
4. Select the Procedure Code for the service provided from the drop-down box.
5. Click ‘Show Services’.
6. Click the ‘Add Ticket’ button.
7. On the ‘Service Data’ tab, enter the date the service was provided. a,c,d
8. Enter the start time of the session.
9. Enter the end time of the session. The Minutes field is then automatically calculated.
10. Indicate if the service was direct, consult or is non-billable. b,f
11. If the service indicated was Personal Care, click on the ‘Personal care’ tab and complete.
Then proceed to step 15.
12. If applicable, click on the ‘Goal’ tab to select the related goal associated with the service.
13. On the ‘Notes’ tab, enter Session Notes including what was accomplished during the session.
Be sure to include all information necessary for Session Notes if required.e,g
14. If applicable, on ‘Signatures’ tab, select/enter up to 3 persons who will sign the record.
15. To add another session, repeat steps 6 through 15 for each session.h
i.
Another option to adding multiple tickets at a time is to use the Additional Dates
feature. See Use Additional Dates in this manual.
Things to Note:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
Much of the information will be filled in automatically when you click ‘Add Ticket’. You should complete any
necessary fields that are not filled in.
All services entered are considered Direct unless otherwise noted in step 11. Neither Consult nor Nonbillable tickets will
be generated in a Medicaid claim.
If there is no diagnosis code for the procedure, select the appropriate diagnosis from the popup window (which will
automatically be used as a default for the procedure in the future). You can also go to How To.... Add a Diagnosis Code
in this manual.
If there is a message about a missing Referring Provider, follow the steps in How To Add a Referring Provider in this
manual. Medicaid requires Referring Providers for Speech Therapy, OT, & PT. The ‘Ref Provider Req’d’ box will be
checked if a Referring Provider is required.
If Session Notes are required, the box will be checked. However, all services should enter some type of note concerning
what activity was performed during the session.
The system is programmed to automatically calculate the billable amount of time that the student was served. You have
the ability to change this time to be whatever you want it to be. For example, Medicaid only allows 4 hours per day for
Psychological Testing. If the assessment personnel used 5 hours that day, the system will bill Medicaid for 5 hours
unless the user changes it to.
If the district uses the IEP writer in SEM, the goals for this student from the IEP will be located in this dropdown box.
If the district uses the IEP writer in SEM, the objectives for this student will be located in this dropdown box.
To copy the goals/notes from the previous session onto this ticket, click the ‘Import from Previous’ button.
If the district uses the IEP writer in SEM, anything typed in the ‘Progress’ field will be available in the IEP/BIP section
of SEM to add to the Progress Report. Clicking ‘Copy Notes’ will copy whatever is in the ‘Notes’ field to the ‘Progress’
field.
Don’t forget to SAVE periodically to avoid losing any data.
‘Co-Teach with Personal Care’ will allow this ticket to be billed if a PCS ticket was also created for this time period.
If this is not checked, the minutes on this ticket will be deducted from any PCS ticket that was created for this time. This
button will not appear on PCS tickets – only on related services.
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Create Records in Services Screenshots
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How to….
Use Additional Dates
Another way to create multiple tickets at one time for the same service on different dates is to use the
Additional Dates screen. (This would take the place of hitting ‘Add Ticket’ each time you wanted to
create a new record).
Follow steps 1-14 on “How to Create a Record for a Completed Session through Services.”
‘SAVE’ the record.
Click ‘Additional Dates’ once you have added and saved a service.
In the last (blank) row, edit the Start Time and End Time as appropriate. The minutes and units
will be calculated automatically once you tab out of the field.h,i
i. For Personal Care tickets, proceed to step 7.
5. If appropriate, enter or select the goal(s) for the ‘ticket’.
i. Click ‘Import’ beneath the ‘Goal(s)’ label to import the goal(s) from the last ‘ticket’ on the
date previous to the ‘ticket’ being entered. Edit as necessary. e
6. Enter the notes for the ‘ticket’. The SEM objective is located under the ‘S’ dropdown. c
i. Click ‘Import’ beneath the ‘Notes’ label to import the notes from the most recent ‘ticket’
on the date previous to the ‘ticket’ being entered. Edit as necessary. e
7. If Personal Care were entered as the procedure, click the ‘Activities of Daily Living’ and
‘Instrumental Activities of Daily Living’ tabs and enter information.e
i. Click ‘Import PC Data’ on the Activities of Daily Living tab to import the notes from the
most recent ‘ticket’ on the date previous to the ‘ticket’ being entered. Edit as necessary.e
8. Repeat steps 4 through 7 for each date that needs to be added.a,b
9. After all ‘tickets’ have been entered, click the ‘Create Tickets’ button.
10. Click ‘Close’ to return to the ‘Services’ screen.
1.
2.
3.
4.
Things to Note:
a.
b.
c.
d.
e.
f.
g.
h.
i.
Tickets should only be done a month at a time on this screen. To begin with a new month, follow step 1 above. The date
range for viewing is listed.
Once you have ‘Created’ the records, you can view them on the Services Data tab by scrolling through. This is where a
ticket would be edited after it is created. NOT on the Additional Dates screen.
The Special Education Manager objectives in the drop-down box (under ‘S’) can be filtered by ‘Goal’, date, and/or by
status at the bottom of the screen.
You can delete the record before you ‘Create’ it by clicking on Delete at the end of the row. If you want to delete it after
you ‘Create’ it, you have to go to the Service Data tab (b) and delete from there.
You can only Import information if a previous ticket with information has been entered for this student and this service.
SEM objectives for that student can be found under the S dropdown. District goals/notes are under D.
Don’t forget to SAVE periodically on the Service Data screen to avoid losing any data.
If any services were scheduled with the Scheduler, you will see them in the upper left-hand column under ‘Scheduled
Services.’ Clicking Add next to that service will bring the scheduled time into the service area below.
‘Co-Teach with Personal Care’ will allow this ticket to be billed if a PCS ticket was also created for this time period.
If this is not checked, the minutes on this ticket will be deducted from any PCS ticket that was created for this time. This
button will not appear on PCS tickets – only on related services.
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Entering Tickets under Additional Dates Screenshots
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How to…
Add a Referring Provider
According to Medicaid criteria, all reimbursement for Physical Therapy, Occupational Therapy, and
Speech Therapy services need a physician’s referral or referring Provider.d Once this step is complete,
the message will no longer appear indicating there is no referring provider.
1. Open the ‘Student Records’ screen.
2. Find the student in the dropdown box.
3. Click on the ‘Physician Approvals/Referring Providers’ tab.
4. Click ‘Add Service’. A blank record will appear after the last completed service record. If you
do not see the blank record, use the vertical scroll bar at the right of the screen or the navigation
buttons at the bottom of the screen to go to the last record.
5. Locate the service in the dropdown box.
6. Put a ‘Start Date’ of that service. The End date is optional. b,c
7. Locate the ‘Physician/Speech Pathologist’ in the drop down box.a
8. Repeat steps 4 through 7 for each service the student is receiving.
9. Select ‘Close’.
Things to Note:
a.
b.
c.
d.
Physicians and Speech Pathologists must be added to the dropdown box in step 7 by the (SM)2 contact person in the
district. If you do not see the name in dropdown box, call that person to get them added to the list.
There must be a Start Date in the field which is generally the FIE or ARD date.
The End Date is optional. If the district would like to track when prescriptions expire, the End Date can be used for this
purpose.
Records can still be created for OT or PT even if there is no physician’s referral. When the record is created, Nonbillable
should be checked on the record. (See How To… Create a Record).
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Adding a Referring Provider Screenshot
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How to…
Add a Diagnosis Code
The ‘Diagnoses’ tab is used to enter diagnoses for the selected student for each service that student
receives. There must be one primary diagnosis for each student. Diagnosis codes can be added in 2
different ways. Method 1 could be used to add a diagnosis before entering any tickets for that student.
Method 2 is used when entering a ticket and the student does not yet have a diagnosis code listed in
Student Records for that service. Once the student has a diagnosis code for that service the message on
the ticket indicating there is no diagnosis listed for that service will no longer appear.
Method 1
1. Click on ‘Student Records’.
2. Locate the ‘Student Name’ in the dropdown box.
3. Click on the ‘Diagnoses’ tab.
4. Click the ‘Add Diagnosis’ button. A blank record will appear after the last completed diagnosis
record. If you do not see the blank record, use the vertical scroll bar at the right of the screen or
the navigation buttons at the bottom of the screen to go to the last record.
5. Select the ‘Diagnosis’ from the drop-down list.d
6. Select the ‘Default Procedure Code’ from the drop-down list.b,c
7. Repeat steps 4 thru 7 for each diagnosis.
8. Click ‘Close’ or another tab.
Method 2
9. After clicking the ‘Add Service’ button in How to… Create a Ticket through Services or the
‘Ticket’ button in How to… Create a Ticket through the Schedule, a box will come up indicating
that there is no diagnosis code associated with that particular procedure. Either click ‘Yes’ to add
it on this screen or ‘No’ to add it through Student Records (Method 1).
i. If you choose Yes, a diagnosis box will appear.
ii. If you choose No, you will return to the ticket. However, all tickets need a diagnosis code
before they will be billed to Medicaid.
10. Select the new diagnosis from the ‘New Diagnosis’ dropdown list or Select next to the diagnosis
you would like to choose in the list of current diagnoses for this student.
11. Click ‘Set Diagnosis and Close.’
12. Click ‘Yes’ to add the diagnosis or ‘No’ to cancel.
Things to Note:
a. There can be only one ‘Primary Diagnosis Qualifier (BK)’. All the rest are ‘Diagnosis Qualifiers’.
b. The procedure code and diagnosis selected will be the default procedure code and diagnosis pair whenever that
procedure is selected.
c. ALWAYS choose the base service (e.g., Speech Therapy, Counseling, Physical Therapy) for the procedure code, not
Speech (Eval), Occupational Therapy- Grp. Choosing group for a service occurs on the record, not here.
d. The diagnosis code is chosen by the Provider or someone in your district. There is no set diagnosis for specific
procedures. A student can and probably will have multiple diagnoses.
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Adding a Diagnosis Screenshots
Method 1
1
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Method 2
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How to…
Print the Monthly Claims Report
Many districts are requiring their Providers to print a monthly report where the Provider signs each
ticket that will be sent to Medicaid. For other How to…Reports refer to the Reports section of this
manual.
This report is called the Services Rendered by Provider report.
Go into the ‘Reports’ section of (SM)2.
Select ‘Services Rendered by Provider’ report.
Click ‘Continue’.
Choose ‘By District’ for all the Provider’s schools or ‘By School’ to print a report for each
school. You can print the report by school or by student. You can select more than one item in
the list by simply clicking on them.
5. ‘Select Students’. Note: Make sure you leave all ‘Enrollment Status’ boxes checked to include
all students you submitted tickets for.
6. Put in the month range of the report you want to run. If you do not enter a date range, you will
get all tickets you have run since the date entered on the Main Menu.d
7. Check the box ‘Students with Medicaid numbers only’. This will ensure that you only print a
report of students eligible for Medicaid.
8. Check ‘Do not include Consults and Nonbillables’ (to print only reimbursable tickets)
9. Check ‘Include Personal Care Detail’ for personal care tickets.
10. Click ‘Preview’ or ‘Print’.a,b,c
1.
2.
3.
4.
Things to Note:
a.
b.
c.
d.
e.
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If you Preview first, you can see which items will be billed, and you can make changes without printing out
incorrect information.
If you are ready to Print, it will print faster if you do not Preview first.
If you get an error message, then you have no claims for that time period for students who are Medicaid eligible.
Verify that the date range for running the report falls after the date on the Main Menu.
Check ‘Include Notes w/ Personal Care Detail’ to include notes that were entered on a ticket on the Notes tab for
students with Personal care.
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Services Rendered Report Screenshots
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SECTION 2. ADMINISTRATIVE HOW TO. . . FUNCTIONS IN (SM)2
(SM)2 is designed to assist Special Education Manager users plan and monitor services prescribed for
the special education students. This module will allow you to track services provided and compare them
with those prescribed by the ARD Committee. Progress can be tracked and easily correlated with the
IEP developed in Special Education Manager. (SM)2 will assist with scheduling so that conflicts are
avoided. It will also help monitor service provider workload.
The two modules, Special Education Manager and (SM)2, are designed to work seamlessly with one
another. Student, staff and school information, as well as information from the ARD, is entered through
Special Education Manager. This data is then used in (SM)2. Students are assigned to service
providers in (SM)2. To address confidentiality issues, users can only view information for those
students who have been assigned to them. Information is updated from Special Education Manager
automatically on a regular basis.
The Medicaid module can be purchased to help maximize Medicaid reimbursements. Medicaid
eligibility is automatically determined for all students in (SM)2. Claims are then generated based on
actual services rendered and student eligibility.
Maintenance of (SM)2 occurs primarily at the beginning of each year. The (SM)2 program can be
purchased with Student Accountability only or with the Medicaid feature added to the Student
Accountability feature. In this manual, if the task is a Medicaid related task, Medicaid will appear in ( )
on that step. If everyone (including Student Accountability) needs to perform the task, ALL will appear
in the ( ) at the end of the task.
(SM)2 without the Medicaid feature requires that the (SM)2 Administrator need only deal with staff
maintenance functions:
A. Assigning staff to students
B. Bringing students into (SM)2
(SM)2 with the Medicaid feature requires additional preparation steps:
Assigning diagnosis for each service provided
Assigning procedure codes for each diagnosis
Assigning referring providers to students, when required
Assigning students to bus routes, when billing for transportation
Identifying billable services
Identifying billable staff
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How to…
Log into (SM)2
1. Locate the user’s last name in Staff Member Name.
2. Enter ‘Password’. This will be the same as your Special Education Manager password if you
are a Special Education Manager user. Note: The password is case sensitive.
3. Click ‘Continue’. The ‘Main Menu’ will appear. Note: The ‘Main Menu’ will look different
depending on your level of SEM access.
4. Doubleclick on Student Services and Medicaid Manager on the ISuite screen.
5. If you have not yet done so, click on the ‘Update Information’ button, and read about the latest
updates to (SM)2.
Logging into SM2 Screenshots
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How to…
Assign Staff Access (ALL)
Staff members who enter records into (SM)2 need to be assigned access to their students.
There are 2 ways to assign access: (SM)2 and SEM.
Ø SEM access is a low maintenance way to assign students to staff. Basically, whichever students
the Provider sees in SEM, they will see in (SM)2.
(Follow steps in “How To…Assign Staff to Students – SEM Access”.)
Ø (SM)2 access requires the administrator to assign specific students to specific Providers. (Follow
steps in “How To…Assign Staff to Students – (SM)2 Access”.)
This preference, whether to assign in (SM)2 or use SEM assignments is done through the Maintenance
screen in (SM)2.
A. (SM)2 Access Type – providers will be assigned in (SM)2 to students. This is generally
performed through the ‘Staff Assignments Wizard’ where the provider, diagnoses, referring
provider, and bus routes can all be assigned to the student at one time. If this option is selected,
refer to “How to… Assign Students in the Staff Assignment Wizard”.
B. SEM Access Type – whichever students the provider can see in SEM, they will be able to see in
(SM)2. If this option is chosen, no other staff assignments need to be made. (For Medicaid, the
students will still need to be assigned diagnoses, referring providers, and bus routes through the
Maintenance screen.) If this option is selected, make sure at least one person (usually the
(SM)2 administrator) remains as (SM)2 Access Type so that when you go into the Staff
Assignments Wizard, you can assign the students not yet in (SM)2 to the Administrator,
then perform all other assignments.
Figure 1. Student Service Assignments
Student Assignments
(SM)
Determine
Access Type –
Maintenance Screen
2
Maintenance Screen
Staff Assignments Wizard
Provider
Diagnosis
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Referring
Provider
SEM
Assign Diagnoses
Bus Route
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Assign Physicians/
Referring Provider
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The above chart describes the student assignment methods for the 2 options: (SM)2 or SEM. If the
(SM)2 method is chosen, students can be assigned all of their necessary components through the ‘Staff
Assignments Wizard’. If the SEM option is chosen, they do not need to be assigned to a provider since
their provider will already be able to access their record. Therefore, they can be assigned their remaining
components through the Maintenance screen.
Note: The SEM method is the least labor intensive of the options.
1. Click on the ‘Maintenance’ button on the ‘Main Menu.’
2. Click the ‘Staff Access and Reimbursement List’.
3. Since this button serves several functions, a prompt will appear reminding the administrator to
select billable staff positions before first entering this screen if they have never done so. Refer to
“Identify Billable Staff” section of this manual to understand this button. Click ‘Yes’.
4. Select ‘Access Type’
a. To bulk assign the ‘Access Type’, place a checkmark in the appropriate box above
‘Mark All’, ‘SM2’ or ‘SEM’, to indicate how students are to be assigned to providers. If
‘SEM’ is chosen in this step, be sure to leave at least one staff member as ‘SM2’ access
type.
b. To individually assign staff to an access type, simply check the appropriate box, ‘SM2’
or ‘SEM’, next to their name.
5. Select ‘Mark All’ and all providers will be assigned to the marked type.
6. Click ‘Close’.
The staff assignments feature is available to level 6 and 7 users only. Users with level 5
access and below will only have access to records of students who have been assigned to
them.
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Assign Staff Access Screenshots
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How to…
Assign Staff to Students – SEM Accessa
Click Maintenance on the Main Menu.
Click ‘Staff Access and Reimbursement List’.
Click ‘Yes’.b
Above the Mark All button, click ‘SEM.’
Click Mark All or put a check next to the specific staff member to be given this access type.
At least ONE person needs to remain (SM)2 access type. This is generally the (SM)2
administrator.
7. Click ‘Close’.
1.
2.
3.
4.
5.
6.
Things to Note:
a. Choosing SEM Access Type for the Providers will allow them to see all students in (SM)2 that they can see in SEM.
b. Medicaid - In step 3, the Administrator should first go into the ‘Identify Billable Staff Positions’ screen before entering
this screen. If this has not been done, select No and go to that screen first.
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Assign Staff Access Screenshots – SEM
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How to…
Assign Staff to Students – (SM)2 Access
Method 1:
1. Click Maintenance on the Main Menu.
2. Click ‘Staff Access and Reimbursement List’.b
3. Click ‘Yes’.
4. Above the Mark All button, click (SM)2.
5. Click Mark All or put a check next to the specific staff member to be given this access.
6. Click CLOSE.
7. Click ‘Staff Assignments Wizard.’
8. Click Next.
9. Filter criteria as needed (i.e., by District, by School, Related Service, etc.).
10. Click Next.
11. Filter criteria as needed (i.e., by Staff, by Position, by School).
12. Click Next.
13. Select students from the list under Student List (Filtered). You can leave them alone to select all
students.
14. Click the > to bring one student at a time over or the >> to bring all students over.
15. Click on the staff member under Staff (Filtered) to whom you want to assign the students.
16. Click the > to bring that staff member over to Selected Staff.
17. Click Next.
18. Click Assign Service Providers.
19. Click Yes to continue with the assignment. No to cancel.
20. Click OK.
21. Click ‘Finish’ then ‘Cancel’ to return to Main Menu.
Method 2:
22. Click on Maintenance on the Main Menu.
23. Click ‘Staff Assignments’.
24. Filter using the tabs as necessary (by School, Service, etc).
25. Follow steps 13 thru 19 above.
26. Click CLOSE.
Things to Note:
a. In steps 2 thru 5, choosing SEM Access Type for the Providers will allow them to see all students in (SM)2 that they can
see in SEM. Choosing (SM)2 Access Type will require the administrator to assign each student to the respective staff
member.
b. Medicaid - In step 3, the Administrator should first go into the ‘Identify Billable Staff Positions’ screen before entering
this screen. If this has not been done, select No and go to that screen first.
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Assign (SM)2 Access Screenshots
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How to…
Import Students from SEM into (SM)2 (ALL)
In (SM)2, students need to be brought in periodically from SEM. Students who are added into SEM
during the year will need to be imported into (SM)2. Examples of these students are new referrals and
students who recently transferred into the district. This step is performed in the Staff Assignments
Wizard by simply checking the “Only Students not in (SM)2” box and following the procedures in the
Staff Assignments Wizard to assign the necessary information (diagnosis, referring provider, etc). The
administrator can decide how often this task is performed (i.e., weekly, monthly).
1. Click on the ‘Staff Assignment Wizard’ on the ‘Main Menu.’
2. Put a checkmark in the box, ‘Only Students not in (SM)2 database.’
3. If ‘Student List (Filtered)’ is empty, there have been no new students added to SEM that are
not yet in (SM)2.a
4. If there are students in the ‘Student List (Filtered)’ box, click ‘Next>’.
5. Click ‘Next>’.
6. Move the student(s) to be assigned using the ‘>’ or ‘>>’ from the ‘Student List (Filtered)’ box to
the ‘Selected Students’ box.
a. > moves one student at a time
b. >> moves all students in list from left to right
7. Move the staff member(s) to be assigned using the > or >> from the ‘Staff (Filtered)’ box to the
‘Selected Staff’ box.
8. Click ‘Next>’.
9. Click ‘Assign Service Providers’.
a. For Medicaid, all other assignments can be made from this point (i.e., Diagnosis code,
Procedure code, Referring Provider, Bus Route. See How to… Assign Student Services
Through Staff Assignment Wizard).a
10. Click ‘Finish’.
Things to Note:
a. Preview Details will print the list of students in the ‘Student List (Filtered)’ with their campus and
related service. This list can be printed before assigning students so that the Medicaid Administrator
can see which diagnosis codes the student needs in step 9, if desired.
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Import SEM students Screenshots
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How to…
Identify Billable Staff for Medicaid
For a service record to be part of a Medicaid claim, the positions as well as individual staff need to be
marked as “billable.”
1. Click ‘Maintenance’ on the ‘Main Menu’.
2. Select ‘Staff Positions Reimbursement Defaults’ to identify which staff positions are allowed
to bill for Medicaid services. This screen should be entered before step 3.
3. Place a checkmark next to each staff position that is allowed to be reimbursed for Medicaid
services (i.e., speech therapist, LSSP). Leave blank any service that cannot get reimbursed for
services provided (i.e., Educational Diagnostician).
4. Select ‘CLOSE’ when done to return to the ‘Maintenance’ menu.
5. Select ‘Staff Access Reimbursement List’ to identify specific individuals who are and are not
able to get reimbursed for services provided. This step should only be done after selecting the
billable services.
6. Place a checkmark next to any individual that was not found in step 5.
7. If this is done during the school year after tickets may have already been entered, click ‘Update
Billable’ and enter the effective date to catch any tickets or service records that were previously
not included in a claim and could have been if the Provider had been marked as billable.
8. Then ‘CLOSE’ to return to the ‘Maintenance’ menu.
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Identify Billable Staff Screenshots
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How to…
Assign Student Services through the Staff Assignments Wizard (M)
Once the student assignments are made, other tasks related to Medicaid services only need to be setup
for accurate billing. (Refer to Figure 1). Use the following for ‘(SM)2 Access Type.’
Each student in (SM)2 must have:
1. Provider(s)
2. Diagnosis for each service provided
3. Procedural Code for each diagnosis
Students may have:
1. Referring Provider (depending on the service)
2. Bus Routes [if transportation will be tracked in (SM2)]
1. Click ‘Staff Assignments Wizard’ on the Main Menu.
2. Click ‘Next >’.
3. The ‘Staff Assignment Wizard – Filter Students’ screen lists all students with SEM history
records between the dates shown on the screen.
a. You can enter a different date range if you need to. The filtered student list (in that date
range) will display only those students with the most recent history record in SEM
between the dates entered.
4. Select the related services and/or speech criteria. Only students who are to receive all services
selected will be displayed in the filtered student list.
5. Select any other filter criteria. Note: Students may not show up on the filtered list because they
do not have an active status in SEM. Use the ‘Include Inactive Students…’ check box to see all
students. Reminder: For districts with SEM data split into schools, (SM)2 only uses SEM data
copied into temporary databases created once a day and derived from the merged database.
6. Click ‘Refresh’ to update the filtered list based on the selected criteria.
7. Click ‘Next>’.
8. The ‘Staff Assignment Wizard – Staff Filter’ screen will open. The initial staff list will include
all active staff in the SEM database. Select the staff filter criteria, including staff positions and
schools. The filtered staff list will be limited to those with the selected positions and who have
been assigned to the selected schools in SEM.
9. Click ‘Refresh’ to update the filtered list based on the selected criteria.
10. Click ‘Next >’.
11. On the ‘Staff Assignments Wizard – Select Students and Staff’ screen move the students to be
assigned to the ‘Selected Students’ box. Note: Double-click on the student name or highlight
the student name and click the single arrow to move the selected student to the opposite side.
Use the double arrow to move all students from one list to the other.
12. Move the service provider(s) to whom the students are to be assigned to the ‘Selected Staff’ box.
Note: Double-click on the staff name or highlight the name and click the single arrow to move
the selected provider to the opposite side. Use the double arrow to move all staff from one list to
the other.
13. Click ‘Next>’.
14. The ‘Staff Assignments Wizard – Assign Students’ screen will open. (If the student and staff
lists are correct, check whether you want to indicate the selected staff as primary provider.)
15. Click ‘Assign Service Providers’ and respond to the message boxes that appear.
16. After the students have been assigned the ‘Assign Diagnoses’, ‘Assign Referring Providers’ and
‘Assign Bus Routes’ buttons will be enabled (active).
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17. We recommend that you assign diagnoses, referring providers and bus routes at this time. They
can also be assigned in bulk through ‘Maintenance’ or for individual students through ‘Student
Records’, both accessed from the ‘Main Menu’.
Assign Diagnoses
18. To assign diagnoses to any subset of this group of students click the ‘Assign Diagnoses’ button.
19. The ‘Assign Diagnosis Wizard’ will open. Move the students to whom the diagnosis is to be
assigned to the ‘Selected Students’ box.
20. Select the desired ‘Diagnosis’ from the drop-down list.
21. Select the default ‘Procedure’ associated with the selected diagnosis. When this procedure is
selected when the detail of services rendered is completed (i.e., a ‘ticket’ is filled out) the
selected diagnosis will automatically be entered on the ‘ticket’. Always select the base service –
never group.
22. Click ‘Assign Diagnosis’ and respond to the message boxes that appear. Note: If this is the first
diagnosis assigned to a student it will be marked as the primary diagnosis.
23. Repeat steps 3 thru 6 until all diagnoses have been assigned.
24. Click Finish.
Assign Referring Providers
25. To assign referring providers to any subset of this group of students click the ‘Assign Referring
Providers’ button. The ‘Assign Referring Providers’ screen will open.
26. Move the students for whom you are assigning a physician/referring provider to the ‘Selected
Students’ box.
27. Select the physician/referring provider. Referring provider data will be filled in automatically.
Note: Referring providers are entered prior to assigning them to students through the ‘Setup
Screen’ access by clicking ‘Options’ on the ‘Main Menu’.
28. Select the ‘Service’ for which the students were referred.
29. Enter the ‘start date’ for the service referral. This is a required field.
30. Click ‘Assign Referring Provider’ and respond to the message boxes that appear.
31. Repeat steps 2 thru 6 for all services for which referring providers are to be assigned for this
group of students (e.g., OT, PT, Speech). Move the students left and right as needed until all
diagnoses are added.
32. Click Finish.
Assign Bus Routes
33. To assign bus routes to any subset of this group of students: Click ‘Assign Bus Routes’. The
‘Assign Bus Routes – Select Students’ screen will open.
34. Move the students to whom you wish to assign a bus route to the ‘Selected Students’ box.
Note: Only students with transportation as a related service and that have a Transportation
Information form will appear in the Student List box.
35. Select the appropriate bus route. Note: Bus routes are created on the Setup screen accessed
through ‘Options’ on the Main Menu. See “How to…Create a Bus Route”.
36. Check whether the selected route is to be assigned for inbound (to school), outbound (from
school) or both.
37. Click ‘Assign Bus Route’.
38. Repeat steps 3 thru 6 until all assignments have been made.
39. Click Finish.
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Staff Assignments Wizard Screenshots
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Understanding the Student Records Screen
The General Student Information screen is a combination of data from Special Education
Manager (e.g. demographics, history, and parent information) and information needed to
complete services rendered ‘tickets’ and generate Medicaid claims. Much of the information
(e.g. diagnoses, transportation information and physician approvals/referring providers) can be
entered in batch mode where multiple students are assigned at a time.
The following is a detailed description of the Student Records screen.
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Preview History
The ‘Preview History’ button allows the user to select a Special Education Manager history
record to preview/print. To view a history record:
1.
2.
3.
4.
5.
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Select the student from the drop-down list.
Select the date of the history record from the ‘History Records’ drop-down list.
Click ‘Preview History’. The history record will be displayed.
To print the history, click the printer icon on the toolbar.
To exit this history record, click ‘Close’.
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Scheduled Services
The ‘Scheduled Services’ function provides a summary of all services scheduled in (SM)2 as well as
meetings for which notices have been generated in Special Education Manager, for an entire year. To
display the schedule:
Select the student from the drop-down list in ‘General Student Information’.
Click the ‘Scheduled Services’ button on the General Student Information screen.
Select the ‘Start Month’ and ‘Start Year’ for the twelve months to be displayed.
Click on any of the “Services Scheduled’ (aqua colored) dates to view the details of the
scheduled services in the ‘Schedule’ box at the top right of the screen. Use the horizontal scroll
bar to move to the right of the ‘Schedule’ box to view more of the details. Note: If there are no
dates with aqua colored backgrounds, there are no scheduled services or meetings. See Legend to
the right of the calendar.
5. Click ‘Close’ to exit the ‘Student Schedule’.
1.
2.
3.
4.
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Demographics
General Information - SEM
Student demographics are imported from Special Education Manager when the student is assigned
service providers in (SM)2. With few exceptions it cannot be edited in (SM)2.
Data is updated
· based on that found in Special Education Manager when the student is selected on this
screen,
· through the Update Student Demographics function found on the Maintenance screen, and
· automatically prior to creation of Medicaid eligibility and claims files.
For those with level 5 and below access, the list of students will be limited to those assigned to the user
who is logged into (SM)2.
The only information entered on the ‘Demographics’ tab are the ‘Release of Information Code’ and the
‘Signature Source Code’, both of which are used for Medicaid Claims submissions. To complete these
fields simply select the appropriate code from the drop-down lists.
General Information – Medicaid
This is the information that is returned with the eligibility from TMHP for that student.
‘Right to Provider Letter Sent’ Checkbox:
The district administrator can check this box indicating they have sent the letter to the parent.
‘Do Not Submit for Eligibility’ Checkbox:
Click this button if the district would not like the student to be included in the list of students for which
that they are requesting eligibility. The student will never be listed as eligible in (SM)2 and their
Medicaid number will never go into SEM.
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Enrollment
The ‘Enrollment’ tab shows information related to the student’s district and campus. It is broken down
slightly differently than it is shown in Special Education Manager, but it is, in fact, imported from
Special Education Manager and cannot be changed in (SM)2.
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Parent Data
The parent information in (SM)2 is used specifically for including “Other Insurance” payments in
Medicaid claims. There are 2 parent tabs on the Student Information screen. Parent 1 is used for the
primary insured and Parent 2 for the secondary insured. If the information is entered in the Medicaid
Parent section of the Parent Information screen in Special Education Manager, some of the parent
demographics will be imported when the student is assigned to service providers. Otherwise, the
information can be entered on these tabs. To enter parent information, including insurance data:
1. Select either the Parent1 tab for primary insured or Parent 2 tab for secondary insured. The
screen shown below will open.
2. Complete the parent demographic information. Note: The insurance indicator check box will
not be available until the parent social security number has been entered.
3. Check the ‘Insurance Indicator’ box to enter insurance company information. Note: A new
insurance record can only be added if all existing records have an ‘End Coverage Date’.
4. Click ‘Update Insured Information’ to automatically complete the demographics portion of the
insurance section.
5. Complete the insurance form at the bottom of the screen.
Note: To change insurance carriers for a parent, enter a date in the ‘End Coverage Date’ field for the
insurer that is being discontinued, click ‘Save’, then click ‘Add’.
Must have a date to
enter a new record
(change insurance).
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information above into
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Physician Approvals/Referring Providers
The ‘Physician Approvals/Referring Providers’ tab is used to enter the referring providers for the
selected student. For assigning referring providers in a batch mode (several students at one time) refer
to ‘Assign Physician Approvals/Referring Providers’ in the ‘Maintenance’ section of this document. To
assign physician approvals/referring providers to the selected student:
1. Click the ‘Physician Approvals/Referring Providers’ tab. The screen shown below will
appear.
2. Click the ‘Add Service’ button. A blank record will appear after the last completed service
record. If you do not see the blank record, use the vertical scroll bar at the right of the screen or
the navigation buttons at the bottom of the screen to go to the last record.
3. Select the ‘Service’ from the drop-down list.
4. Enter the ‘Start Date’ as indicated by the physician/referring provider.
5. Select the ‘Approving Physician’ from the drop-down list. The other fields related to the
selected person will be filled in automatically. If the physician or speech pathologist is not in the
list, contact the Medicaid Administrator in your district. These individuals are added through
Options by the Administrator in the district.
6. Click ‘Save’ to save your entries.
7. Repeat steps 2 thru 6 for each service the student is receiving.
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Diagnoses
The ‘Diagnoses’ tab is used to enter diagnoses for the selected student. There must be one primary
diagnosis for each student. To enter diagnoses in a batch mode (several students at one time) refer to
‘Assign Diagnoses’ in the ‘Maintenance’ section of this document. To assign diagnoses for the selected
student:
1. Click on the ‘Diagnoses’ tab. The screen shown below will appear.
2. Click the ‘Add Diagnosis’ button. A blank record will appear after the last completed diagnosis
record. If you do not see the blank record, use the vertical scroll bar at the right of the screen or
the navigation buttons at the bottom of the screen to go to the last record.
3. Select the ‘Diagnosis Qualifier’. Note: There can be only one ‘Primary Diagnosis Qualifier
(BK)’.
4. Select the ‘Diagnosis’ from the drop-down list.
5. Select the ‘Default Procedure Code’ from the drop-down list. When this procedure is the basis
for services rendered ‘tickets’ this diagnosis will automatically be included on the ‘ticket’.
6. Repeat steps 2 thru 5 for each diagnosis.
7. Click ‘Close’ or another tab.
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Transportation
The ‘Transportation’ tab is used to assign/change the bus routes and to indicate whether the selected
student receives special shuttle services. Bus routes can be assigned in a batch mode (several students
assigned at one time) through the ‘Assign Bus Routes’ function found on the ‘Transportation’ screen.
1. Click the ‘Transportation’ tab. The screen shown below will appear.
2. Select the inbound and outbound bus route for the student from the corresponding drop-down
lists.a
3. Use the check box to indicate whether the student receives shuttle services.
Things to Note:
a. If the bus route is not listed in the dropdown box in step 2, see How to…Create Bus Routes in this manual.
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Staff Assignments
The individual Providers assigned to each student can be viewed here. This function is only meaningful
for those staff members with (SM)2 Access Type. If the Provider’s have SEM Staff Access Type, they
will not be listed here. (See “How to… Assign Staff Access” in this manual.) Staff members cannot be
assigned/added here. See “How to …Assign Staff to Students” in this manual.
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Eligibility
Student’s eligibility for Medicaid reimbursement can be viewed on this screen. If the student is eligible,
there will be an entry for each occurrence that the district requested eligibility information.
For example, you will note that eligibility for this student began August 1, 2004. He then became
ineligible until February 1, 2007. Each entry listed is an eligibility request that was made to TMHP by
the district. TMHP does not know if a student will be eligible for services “tomorrow.” They only know
up until the day they send the file back to the district indicating who is eligible for Medicaid.
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How to…
Understand the Maintenance screen
The Maintenance screen has features to facilitate student assignments (e.g. referring providers and
diagnoses), create and edit school calendars for use with the Scheduler, update student demographics
from the Special Education Manager database, develop custom pop-ups and compact and repair data
files. The following are detailed descriptions of the functions accessed through the maintenance screen.
HYPERLINKS CAN BE ACCESS BY CLICKING ON NUMBER IN GRAPHIC BELOW.
1. Update Student Demographics
This feature was included to keep student demographic and enrollment information up-to-date and
consistent in both (SM)2 and Special Education Manager. Changes to student demographics and
enrollment information are made in Special Education Manager. Prior to generating TMHP Medicaid
eligibility or claims files the demographics and enrollment information for all students in the (SM)2
database are automatically updated. When individual students are selected on the Student Records
screen this information is updated as well. There may be instances where you want to manually update
the demographics (e.g. prior to running reports where the information is important), in which case this
feature is used. To update the demographics and enrollment information for all students in the (SM)2
database simply click the ‘Update Student Demographics’ button on the Maintenance screen and
respond to the message box that appears.
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2. Change Student ID
This function is used to change a student’s ID (e.g. SSN) in the (SM)2 database and merge records. The
ID is changed for all records in all tables. Note: Remember that student demographic information, etc.
is updated from the Special Education Manager databases. The ID must, therefore, be the same in both
databases. Having different IDs will result in undesirable effects.
This feature will merge all student records in (SM)2 if a student is in the program twice.
To change a student’s ID:
1. Click ‘Change Student ID’ on the Maintenance screen.
2. Enter the old student ID in the ‘Old SSN’ box. The student name and date of birth will be filled
in automatically in the appropriate fields. Verify that this is the correct student.
3. Enter the new student ID in the ‘New SSN’ box.
4. Click ‘Change ID’ and respond to the message boxes that appear.
3. Delete Student from (SM)2
Use this feature to delete a student from the (SM)2 database. Note: Deleting a student will delete all
references to that student, including Services Rendered ‘Tickets’ and Claims.
To Delete a Student:
1. Click ‘Delete Student from (SM)2’ on the Maintenance screen.
2. The Delete Student screen will open.
3. Select the student to be deleted from the drop-down list. The ID and date of birth will be filled
in automatically.
4. Click ‘Delete’ and respond to the message boxes that appear.
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4. Update Medicaid IDs in Special Education Manager
Medicaid IDs in (SM)2 are updated when responses to Medicaid eligibility submittals from TMHP are
parsed. This feature replaces the Medicaid IDs in SEM with those obtained from TMHP. Updates are
made in all folders (e.g. merged and school folders). The new IDs are placed in student information and
will be included in footers of forms completed in SEM after the update.
5. Parental Consent Tracker
Parental Consent for billing Medicaid is tracked in (SM)2 from both SEM entries as well as (SM)2
entries.
In SEM, parental consent is entered in 2 places:
On the SHARS letter
On the Signature Page of the ARD (page 7)
In (SM)2, parental consent is indicated from SEM on the Maintenance screen under Parental Consent
Tracker. If consent is obtained in SEM, it will appear here. However, the administrator can also
manually enter obtained parental consent on this screen.
1. Click on the Maintenance screen on the ‘Main Menu’ in (SM)2.
2. Click on ‘Parental Consent Tracker.’
3. To locate a particular student, either click on the name in the upper lefthand box or select their
name from the list ‘Select Student from List Above or Below’.
4. If consent was obtained, there will be ‘Consent Start’ and ‘Consent End’ date(s) as well as the
Parent’s Name.
5. If no consent was obtained, the consent area will be blank.
6. In order for the student to be included in a Medicaid claim, they must have consent dates that fall
within the range for which the claim will be created.
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6. Beginning of Year Preparation
The Beginning of Year Preparation is used to reset pertinent information before reassigning students to
service providers and reassigning bus routes to students. NOTE: THESE FUNCTIONS ARE RUN IN
BATCH MODE. THIS MEANS THEY AFFECT ALL STUDENTS. This function should not be used
until the Special Education Manager ‘Year End Rollover” has been completed.
To prepare for a new school year:
1. Click ‘Maintenance’ on the Main Menu.
2. Click ‘Beginning of Year Preparation’. The following screen will open.
3. Click ‘Clear All Staff Assignments’ and respond appropriately to the prompts. Note: Those with
level 5 access and below will not be able to see any students after you have cleared the
assignments.
4. Click ‘Clear ALL Bus Routes’ and respond appropriately to the prompts. Note: You must
reassign bus routes before students will show up in the Transportation Log.
5. Click Close.
7. Year-End Maintenance
This function is performed by GG Consulting, LLC and removes old tickets from the active database by
archiving them into a folder on the server.
8. Backup
This function is performed each night as part of the nightly functions. The administrator can also click
this button to perform a backup.
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9. Staff Assignments
To assign services providers using the Staff Assignments screen:
1. Click Maintenance on the Main Menu, then Staff Assignments. The Assign Service Providers
screen will open. Be patient, there is a lot of information being queried from SEM data.
2. Enter a range of dates in the ‘From Records Between fields. Only students with History records
in SEM between the dates entered, will appear in the ‘All Students’ list box.
3. Select the ‘Student Filters’ tab. The following screen will appear.
4. Select the desired filter criteria. Click Refresh Student List to view the filtered list.
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To filter the staff list by staff position and/or schools, select the ‘Staff Filters’ tab.
Select the desired staff filter criteria. Click Refresh Student List to view the filtered list.
Click the ‘Assign Service Providers’ tab.
Move the students to be assigned to the Selected Students box using by highlighting the student
in the ‘All Students’ box and clicking the ‘>’ (or double-click on the student). To move all
students click the ‘>>’.
9. Move the service providers to be assigned to the ‘Selected Staff’ box.
10. If you have selected the primary provider click the ‘Primary Service Provider’ box.
11. Click ‘Assign Service Providers’.
12. Repeat steps 3 thru 11 for additional student and staff combinations.
5.
6.
7.
8.
Changing Staff Assignments
The ‘Change Assignments’ tab is used to
Ø Change staff assignments
Ø Co-assign staff to students
Ø Remove staff assignments.
13. Click the ‘Change Assignments’ tab.
14. A list of students assigned to the selected service provider will appear in the ‘Current
Assignments’ box. Select the service provider whose assignments are to be changed/removed or
to be co-assigned.
15. Move the students to be reassigned/co-assigned or removed to the ‘Assignees’ box.
16. Select the desired action (Reassign, Co-assign or Remove). The caption on the action button will
change based on your selection.
17. If Reassign or Co-assign is selected, select the staff member to whom the students are to be
reassigned or co-assigned. This box will appear when Reassign is selected.
18. Select whether the new service provider will be a primary provider – optional.
19. Click the action button (Reassign, Co-assign or Remove).
20. Click ‘Close’ to exit this screen.
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How to…
Delete a Provider’s Schedule
21. Click on the ‘Manage Schedules’ tab.
22. Select the Provider from the dropdown list. All scheduled services will be listed.
23. Put in a start date of the schedule to delete. All schedules services after this date will be listed.
24. Click on ‘Delete Schedule On and After Selected Date.’ This button will appear when a date is
entered.
25. Click Yes for the next 3 prompts to confirm the deletion.
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10. Assign Diagnoses
The Assign Diagnoses function is used to assign the same diagnosis to a group of students. To bulk
assign diagnosis codes:
1. Click ‘Assign Diagnoses’ on the Maintenance screen.
2. Enter the date range during which the students receive the services selected on the ‘Student
Filters’ tab.
3. To filter the list of students by service, select the Student Filters tab.
4. Select the related service(s). Note: Multiple related services can be selected but the student
would need to have each of them. It is better to select one at a time.
5. Select the speech option.
6. Select the Assign Diagnoses tab.
7. Move the students to be assigned from the All Students list box to the Selected Students list box.
Highlight (click on) the student name and click the single arrow, or double-click on the student
name, to move one student from one list to the other, or use the double arrows to move all
students from one list to the other.
8. Select the Diagnosis to be assigned.
9. Select the default service for this diagnosis.a
10. Click the ‘Assign Diagnosis’ button.
11. Repeat steps 3 thru 10 for additional diagnoses.
Things to Note
a.
When a procedure is selected for a “ticket” or record, whatever diagnosis code was associated with this procedure in the
above steps will be the diagnosis code that will appear on that service record. Always select the base service and this
diagnosis will appear on the ticket whether or not it was individual or group.
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Assign Diagnoses thru Maintenance Screenshots
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11. Assign Referring Providers
All students who receive Speech Therapy, Occupational Therapy, or Physical Therapy must have a
Referring Provider before billing Medicaid. This information can be kept separately in the district or
they can be entered into the system. This step will show the Administrator how to bulk assign Referring
Providers to students.
1. Click ‘Assign Referring Providers’ button in Maintenance.
2. Move the students for whom you are assigning a physician/referring provider to the ‘Selected
Students’ box.
3. Select the physician/referring provider. Referring provider data will be filled in automatically.
Note: Referring providers are entered prior to assigning them to students through the ‘Setup
Screen’ access by clicking ‘Options’ on the ‘Main Menu’.
4. Select the ‘Service’ for which the students were referred.
5. Enter the ‘start date’ for the service referral. This is a required field.
6. Click ‘Assign Referring Provider’ and respond to the message boxes that appear.
7. Repeat steps 2 thru 6 for all services for which referring providers are to be assigned for this
group of students (e.g., OT, PT, Speech). Move the students left and right as needed until all
diagnoses are added.
8. Click Close to exit.
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12. Assign Students to Bus Routes
All bus routes should be created (see Creating Bus Routes) prior to assigning students to the routes. To
assign students to the previously created bus routes:
1. From the Main Menu click ‘Maintenance’.
2. Click ‘Assign Bus Routes’.
3. Enter the Begin Date Receiving Transportation. The list of students shown will be all students
receiving Transportation as a related service on the specified date per the Student History in SEM.
4. If you want a list of students filtered by school(s) click the ‘Student Filters’ tab. If not, go to step 8.
5. Highlight the school(s) to filter the students by (you may select more than one school).
6. Click the ‘Assign Bus Routes’ tab.
7. Click ‘Refresh Student List’.
8. Select the students (move them to the ‘Selected Students’ list box) to be assigned to the same bus
route. To move one student from one list to the other, highlight the name and click the single arrow
or double-click on the name. To move all students from one list to the other, click the double arrow.
9. Select the bus route and direction (Inbound, Outbound, or both, or if this is a Shuttle route) to which
the selected students are to be assigned.
10. Click ‘Assign Bus Route’ and respond to the message box that appears.
11. To assign additional bus routes, repeat steps 3 thru 10.
12. Click ‘Close’ to exit this screen.
Assign Students to Bus Routes Screenshots
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13. Pop-up Editor
The Pop-up Editor is used to enter/edit pop-ups entries developed by the user. Currently, there are 2
such lists:
Ø Services Rendered Notes: can be selected from a drop-down list on the Notes tab of the Services
Rendered screen to facilitate entry into the Notes field.
Ø Custom IEP Goals: can be selected from a drop-down list on the Goals-Assessments-Related
Services tab of the Services Rendered screen. These goals are in lieu of or in addition to those
that are automatically retrieved from the students’ IEP/BIP developed in SEM.
To enter/edit pop-up lists:
1. Click ‘Pop-up Editor’ on the Maintenance screen.
2. Select the pop-up to edit from the drop-down list.
3. To add a new item click the ‘Add’ button or to edit an item search for the item using the
navigation buttons at the bottom of the screen.
4. Enter or edit the text. You can double-click the field to open the text import screen where spell
check is also available. Note: The maximum number of characters allowed will appear in the
field below the text.
5. Verity that the ‘Active’ box is checked if the item is to appear in the corresponding drop-down
list, otherwise, uncheck the box.
6. Repeat steps 3 thru 5 for as many items as desired.
7. Click ‘Close’ to return to the Maintenance screen.
To delete items from a pop-up list:
8. Click ‘Pop-up Editor’ on the Maintenance screen.
9. Select the pop-up from which the item(s) is to be deleted from the drop-down list.
10. Search for the item to be deleted using the navigation buttons at the bottom of the screen.
11. Click the ‘Delete’ button.
12. Repeat steps 3 thru 4 for as many items as desired.
13. Click ‘Close’ to return to the Maintenance screen.
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14. Edit Diagnosis Defaults
This feature is used to enter/edit the default diagnosis codes for the procedures. Each ‘ticket’ must have
a diagnosis code. If there is no default code when the ‘ticket’ is created the user will be prompted to
select one. The selected diagnosis code will be added to the student’s list of diagnoses.
To enter/edit default diagnosis codes:
1. Click the ‘Edit Diagnosis Defaults’ button.
2. Select the default diagnosis code from the drop-down list for each procedure listed.
3. Click ‘Close’.
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15. Remove Student Assignments
The Remove Student Assignments function is used to remove student’s staff lists. If the SEM Access
Type is used, this step will rarely be needed. The students remain in the (SM)2 database but can only be
accessed by level 6 and 7 users. To remove student assignments:
1. Click the Remove Student Assignments button on the Maintenance screen.
2. Filter the list of students in the ‘All Students’ box by selecting the appropriate filters on the
‘Student Filters’ tab.
3. Click ‘Refresh Student List’.
4. Move the students to be “unassigned” to the ‘Selected Students’ list.
5. Click ‘Remove Assignments’.
16. Staff Positions Reimbursement Defaults
See How to…Indentify Billable Staff for Medicaid
17. Staff Access and Reimbursement List
This section allows the administrator to set access levels in (SM)2 as well as determine which staff are
and are not billable. See Assign Staff Access (ALL)
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18. Enter/Edit Medicaid Rates
As of September 1, 2006 each district will have its own set of Medicaid reimbursement rates. This
means a different set of rates for each district in cooperatives and shared services arrangements. The
“Enter/Edit Medicaid Rate” function is used to enter the rates for each district. Claims should not be
filed until rates are available for each district. If a rate does not exist for a given year, $0.00 will be used
when the claims are built and these claims will not be submitted. This screen should be updated at the
beginning of each fiscal year (October 1st) by clicking the ‘Import Rates from Previous Year’ and
editing as necessary.
1. Click ‘Enter/Edit Medicaid Rates’ on the Maintenance screen.
2. Select the district for which you will be entering rates from the ‘District (Billing Provider)’
drop-down list.
3. If, for some reason (this has previously been the case) the rates for more than one unit are
different than the (number of units)*(rate for one unit), uncheck the ‘Show rate for one unit
only’ check box.
4. Click ‘Show Rates’.
5. Enter the rates and recommended maximum units for each type of service paying special
attention to group rates, rates for services provided by assistants, etc. As the rate for one unit is
entered, the rates for multiple units will automatically be calculated. Make changes as
necessary. The default for the recommended maximum units will come from the previous
year.
a. The district can select “Do Not Bill” for a service not performed in the district (e.g.,
Medical Services).
6. Repeat steps 2 thru 5 for all districts.
7. Click Close.
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19. Set School Calendars
School calendars are used to facilitate scheduling. They do not restrict scheduling, nor does the
selection of a given school calendar restrict the list of students to those on the selected campus. If
calendars are not entered, the only “non-school” days will be weekends. You need only enter the
calendar for schools having the same schedule once. To enter school calendars:
1. Click ‘Set School Calendars’ on the Maintenance screen.
2. Select the school for which you are entering the calendar. The start and end date for that school
will be retrieved from the Special Education Manager database.
3. Select the month and year for which you want to enter the calendar.
4. Select the date(s) to be marked as no school days. A list of dates selected will appear to the right
of the calendar.
Note: To select a continuous range of dates, click on the first date, hold the shift key and click on
the last date. To select more than one non-continuous (random) dates, click on the first date,
hold the Ctrl key and click on the remaining dates.
5. Select ‘No School’ from the option group that appears to the right of the calendar.
6. Click the ‘Set’ button. The days will appear in red.
7. Select the date(s) to be marked as partial days. A list of dates selected will appear to the right of
the calendar.
8. Select ‘Partial Day’ from the option group at the right of the calendar.
9. Enter the ‘Start Time’ and ‘End Time’ for the partial day(s).
10. Click the ‘Set’ button. The days will appear in yellow.
11. Repeat steps 3 thru 10 for all months of the year.
12. To align calendars for additional schools to that just entered, click the ‘Align School Calendars’
button. The ‘Select Schools to Align’ and ‘To Be Aligned’ list boxes will appear.
13. Move the schools to be aligned to the ‘To Be Aligned’ using the arrows or by double-clicking.
14. Click the ‘Align’ button.
15. Repeat steps 2 thru 14 for all different calendars.
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20. Re-parse Transportation Claim Responses
This function fixed a problem some users were having parsing these claims. Contact GG Consulting
before using this function.
21. Reset Denied Transportation Claims for Resubmittal
This function fixed a problem some users were having parsing these claims. Contact GG Consulting
before using this function.
22. Update “TMHP No Response” Claims
This function fixed parsed past no response claims after GG Consulting . Contact GG Consulting before
using this function.
23. Compact/Repair Databases
This utility is used for two purposes:
Ø Compact the databases for program performance optimization. This is done automatically each
night with server’s nightly functions. However, the administrator can do this any time
performance seems to have slowed.
Ø Repair database when files have become corrupt. File corruption is rare, but can occur when
there is an abnormal program termination when accessing data. The typical error message
associated with a corrupt database is ‘Unrecognizable database format…’ You should only
repair databases if they are corrupt.
To Compact/Repair databases:
1. Click the ‘Compact/Repair Databases’ button on the Maintenance screen. Select the database(s)
on which the action(s) is/are to be performed.
2. The default is the path to the Current File or enter the path to the selected database(s). Generally,
each file will have a different path (e.g. Temporary file will be Y:). If this is the case, only select
one file at a time (Data or Temporary).
3. Click ‘Compact’.
4. Repeat steps 2 through 4 for the other database.
5. Click ‘Close’ to exit.
20. IEP Ratios
The program will assist the business office in the district with the information needed for the Cost
Report. See the section Calculate the IEP Ratio for the SHARS Cost Report.
25. Right to Provider Letter Tracking
This button will list all students who have yet to have the Right to Provider letter given to them by the
district. This function is tracked on the Student Records screen on the General tab. If a checkmark is
placed in the “Right to Provider Letter Sent” box, the student will no longer appear on this list.
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Transportation
Special transportation services are tracked for rides to and from school as well as for shuttle services
provided throughout the day. It works like this:
Bus routes are defined and students are assigned to the routes. For each ride to or from school (or
shuttle ride) the service provider (bus driver) indicates on a preprinted form whether expected riders
were on the bus. They can also enter the time the students were picked up and dropped off and notes for
each ride. The paper log is given to a data entry clerk for entry into (SM)2 Individual rides, including
shuttle services, can also be entered for individual students.. At the end of each month, the (SM)2
administrator creates services rendered tickets based on the transportation log. If Medicaid claims are
created using (SM)2, claims for transportation services will only be generated if other services were
provided on that day.
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How to…
Create Bus Routes in Options
All bus routes need to be entered into the system prior to assigning students to the routes.
1.
2.
3.
4.
5.
6.
7.
8.
9.
From the ‘Main Menu’ click ‘Options’ to open the ‘Setup Information’ screen.
Click the ‘Bus Routes’ tab. A list of existing bus routes will appear at the top of the form.
Click ‘Add Route’.
Enter the route name in the appropriate field. Note: the ‘Route Number’ will be automatically
filled in after the name is entered.
Use the checkbox to indicate whether this is a shuttle route.
Select the default school from the drop-down list.
Select the inbound and outbound drivers from the corresponding drop-down lists. Note: The
drivers must have been previously entered as staff in SEM.
Click ‘Save’.
To add another route, repeat steps 3 thru 7.
Note: To make changes to any of the entries for a specific route, highlight the route in the ‘Bus Routes’
box at the top of the form and make the appropriate changes below.
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How to…
Enter Rides in the Transportation Log
The transportation department notates when a student was absent or present for each leg of the ride. This
information needs to be entered into (SM)2.
1.
2.
3.
4.
5.
6.
7.
8.
Click ‘Transportation’ on the ‘Main Menu’.
Click ‘Transportation Log’. (This may take a few seconds.)
Indicate if you want (SM)2 to check the student history in SEM to determine whether the
student is scheduled to receive transportation according to the ARD for each day of the month
for which you will be entering the log. Note: It may take several seconds/minutes to run this
check after you select a new month and year.
Select the ‘Month’ and ‘Year’ for the log you wish to enter.
Select the first ‘Bus Route’ you are going to enter
Place a check in the box for each date and direction (AM and/or PM) that the student rode the
bus.
Use the ‘Mark All’ button to mark each weekday.
Repeat steps 5 and 6 for each to be entered in this session.
Things to Note:
a.
b.
Pay attention to the “AM” and “PM” rows. Students who ride a different bus to school than home from school will only
have one line on each route.
If you opted to check the student history for transportation as a related service for each day a red underscore will appear
under the days that the student DOES NOT have transportation as a related service.
Transportation Log Screenshots
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How to…
Enter Personal Care On the Bus
Checking the ‘Personal Care on Bus Log’ box converts the Transportation Log to one where you are
able to log personal care services.
Note: You must complete the Transportation Log before making entries for personal care as you will not
be allowed to indicate personal care services on the bus unless the student is marked as being on the bus
first.
To indicate personal care on the bus:
1. Follow steps 1 to 7 under “Entering Rides in the Transportation Log.”
2. Place a check in the ‘Personal Care on Bus Log’ box. Select whether personal care was
provided for an individual or a group. The default is personal care in a group.
3. Enter relevant notes in the appropriate field.
4. Click ‘Close’.
To review/edit/delete personal care on the bus entries:
5. Click on the previously checked box.
6. Select whether you want to review or delete the information entered. If you select to review the
information, the input screen seen below will open.
7. Make changes as necessary.
8. Click Close.
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How to…
Enter Individual Rides
Note: Two round trip shuttle services can be entered for each student each day.
To enter individual rides:
1. Click ‘Transportation’ on the Main Menu.
2. Click ‘Review/Edit Transportation Entries’ or ‘Shuttle Service’ and the Transportation Log
screen will open.
3. To limit the list of student to those with shuttle services indicated on the SEM Transportation
Information form, check the ‘List students with shuttle indicator(s) only’ box.
4. To limit the list of students to those attending a specific campus (current campus) select the
campus from the ‘List students enrolled in:’ field.
5. Click ‘Refresh Student List’.
6. Enter the date the service was provided in the ‘Service Date’ field.
7. Select the student for whom rides are to be recorded or edited.
8. Select ‘To/From School’, ‘Shuttle 1’, or ‘Shuttle 2’. ‘To/From School’ can be used to enter or
edit rides to or from school ‘Shuttle 1’ and ‘Shuttle 2’ are used to enter up to 2 round trip
shuttle services per day.
9. In the blank record indicate whether the ride was inbound or outbound.
10. Enter the ‘pick-up’ and ‘drop-off’ times.
11. Select or enter the ‘pick-up’ and ‘drop-off’ locations.
12. Select or enter the ‘driver name’.
13. Enter notes, if necessary.
14. Repeat steps 9 thru 13 to enter another ride record for the opposite direction (inbound or
outbound).
15. Repeat steps 7 thru 14 to enter rides for additional students.
16. Click ‘Close’ to return to the Transportation Menu.
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Enter Individual Transportation Entries Screenshots
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How to…
Edit Transportation Log Entries
Note: Changes to the transportation log will not be reflected on services rendered ‘tickets’ previously
created from the log. There are two methods for editing transportation log entries. In the first, Method
I, modifications are made through the daily Transportation Log screen. Method II can be used to
edit/enter log data for selected students and dates. The two methods are outlined below:
Method I
1.
2.
3.
4.
5.
6.
7.
8.
9.
Click ‘Transportation’ on the ‘Main Menu’. The Transportation window will open.
Click ‘Transportation Log’. The Transportation Log will open.
Enter the service date of the entry(ies) to be edited.
Select ‘Inbound’ or ‘Outbound’.
Select the bus route for the entry(ies) to be edited.
Highlight the student name in the left pane to open the log entry in the right pane.
Make the necessary changes to the log.
Click ‘Save Log(s)’.
Click ‘Close’ to return to the Transportation Menu.
Method II
Click ‘Transportation’ on the Main Menu. The Transportation window will open.
Click ‘Transportation Log’. The Transportation Log will open.
Click ‘Review/Edit Transportation Entries’.
Enter the service date.
Select the student from the ‘Student’ drop-down list.
To filter the list of students in the list you can select a school from the ‘List students enrolled in:’
box to limit the list to students with a current campus of the school selected.
7. Check ‘List students with shuttle service indicator(s) only’ box to limit the list to students with
shuttle service indicators on their Transportation Information form.
8. Click ‘Refresh Student List’ after selecting or removing any filters.
9. Select the transportation type to be edited (i.e. To/From School, Shuttle 1 or Shuttle 2).
10. Make the necessary changes to the log.
11. Click ‘Close’ to return to the Transportation Log.
1.
2.
3.
4.
5.
6.
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How to…
Create Transportation ‘Tickets’
Transportation services rendered ‘tickets’ are created based on the transportation log entries. Just
because a student was present in the log does not mean they automatically qualify for transportation
reimbursement. A reimbursable service must have been performed on the day of the ride. Therefore, the
Transportation Log rides must be converted into qualifying tickets.
‘Tickets’ are generated for all rides provided between specified dates. One ‘ticket’ is created for
qualifying rides (rides on dates when other services were provided) and another is created for nonqualifying rides (no other services were provided on the day of the ride(s)). Note: For Medicaid eligible
students claims will be generated based on qualifying ‘tickets’ only. It is recommended that
transportation ‘tickets’ be created once a month (just prior to submitting Medicaid claims, if applicable).
The ‘tickets’ are generated as follows:
1. Click ‘Transportation’ on the ‘Main Menu’. The Transportation window will open.
2. Click ‘Build Services Rendered from Log’. The Build Services Rendered From Transportation
Log screen will open.
3. Enter the date range for transportation log entries from which the services rendered ‘tickets’ are
to be generated in the ‘Use Log Entries from’ and ‘to’ fields.
4. Click ‘Create Services Rendered Tickets’.
5. Close the message box indicating that the tickets have been created.
6. Click ‘Close’ to return to the Transportation Menu.
Note: Refer to Services Rendered to review/edit transportation ‘tickets’.
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SECTION 3. MEDICAID REIMBURSEMENT
While (SM)2 is designed to track services provided to all students, the data is maintained in a format to
automate the Medicaid filing process. Demographic information is used to automatically create the
eligibility upload file (270 file) for submission to TMHP. The TMHP eligibility response file (271) is
parsed and claims are generated for eligible services rendered. The claims upload file (837) is then
automatically created for submission to TMHP. The claims response files (27S and 835) are parsed for
reporting. All functions associated with Medicaid are designed for use by the Medicaid coordinator.
Shared send and receive folders as defined on the Options screen should be created on the coordinator’s
workstation.
The Medicaid Billing Process
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Assistance with Eligibility and Claims
TMHP Toll Free Number: (888) 863-3638
Call TMHP to get help for a particular claim or eligibility questions.
EDI Help Desk – same number
For any questions regarding the electronic records on the TMHP FTP site.
www.TMHP.com
Once the (SM)2 Administrator has created a Username and Password for the site, they can then
login to view current eligibility for a student as well as view claim status. When logging into this
site and setting preferences, make sure the district chooses to receive BOTH electronic and paper
copies of the R&S report. Without the electronic copy on the ftp://edi.tmhp.com site, there will
be no way to resolve the SENT claims in (SM)2 which will cause incorrect Reports in (SM)2.
Medicaid Terminology
a. Diagnosis Code – all students need to have a diagnosis code associated with each record.
Typically, the Provider would determine what diagnosis to use for that student.
b. Procedure Code – all Medicaid reimbursable procedures such as Speech Therapy have a
Procedure Code as listed in the Billing Guidelines.
c. Referring Provider – students who receive Speech Therapy, OT, or PT need to have a Referring
Provider.
d. Eligibility – Administrators can request a current eligibility at any time. However, in order to
create a claim, eligibility must have been obtained for the time period that the claim will cover.
For example, to create a claim for the month of October, the Administrator will need to request
from TMHP which students were eligible for Medicaid in October.
e. R&S Report – paper documentation from TMHP regarding payments for a claim.
f. TMHP file codes:
.270 – File extension of eligibility file sent TO TMHP.
.271 – File extension of eligibility file received FROM TMHP.
.837 – File extension of claim sent TO TMHP for reimbursement.
.835 – File extension of paid claims received FROM TMHP.
When .270 or .837 files are sent to TMHP, they “immediately” send back several files indicating
that they have received the submission and whether or not the files have been accepted or
rejected.
.BID – File indicating TMHP has received either the file just sent (.270 or .837)
.REJ – List of records in the file that were rejected. If the file is 1kb, no files were rejected.
.ACC – List of records in the file that were accepted.
.27s – List of what has been paid.
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How to…
Identify Medicaid Eligibility in (SM)2
Eligibility files (270) must be created, submitted, retrieved and parsed prior to creating the Claims (837)
file. Information in the eligibility response file (271) is used to determine which services are to be
submitted as claims. This process can be done anytime the district would like a current eligibility for
students.
1. Click ‘Eligibility’ on the ‘Main Menu’.
2. Select the ‘month’ and ‘year’ for which you are determining eligibility or just leave the default
date that is already in the blank. This will typically be the month previous to the current month,
i.e., the month in which the services were provided.
3. Click ‘Create Eligibility (270) for Upload’.a,d
4. See “Submit Files to TMHP” for file submittal instructions.
i. After this step, the administrator will need to wait several hours to a day before
proceeding to step 5. TMHP has to process the file sent in this step.
5. See “Retrieve Files from TMHP” for file retrieval instructions.
6. Click on ‘TMHP Response on the Main Menu’.
7. Click on ‘Parse Eligibility Response – 271’.
8. Follow the prompts. If you would like to update SEM with the ID numbers, you can select the
prompt to do so.
9. Click CLOSE when done.
Things to Note:
a.
b.
c.
d.
e.
To preview the 270 file, click ‘Open Current Eligibility (270) in Notepad’. This file is generally “unreadable” as it is in
the HIPAA format.
To preview the Error file generated when the 270 was created click ‘Open Error Log’. See Open Existing Files for
information on how to open error files.
To preview any of the 270 files that have been created and saved click ‘Preview Eligibility (270) Files’.
In step 3, after the 270 file has been created, (SM)2 will automatically try to copy the file to the ‘Send’ folder on the local
workstation for submittal to TMHP. The path to which the file will be copied is defined on the ‘Options’ screen
accessed from the ‘Main Menu’.
In step 8, when (SM)2 updates SEM with the student’s Medicaid number, it does not take the number off of students who
were not eligible if they have been eligible in past submissions. Therefore, a student may have a Medicaid number but
are not “currently” eligible. However, if another eligibility is run in the future, a student may be backdated by TMHP to
be eligible for reimbursement. The purpose of leaving the number on the student’s record is that the Medicaid ID needs
to be placed on the ARD document in case they again become eligible in the future.
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Eligibility Screenshots
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Steps to Take Before Creating a Medicaid Claim
Taking these steps will help to ensure a successful claim creation.
Verify….
ALL services for the date range for which to build the claim have been entered into (SM)2.
Everyone needs to have finished entering their tickets for the date range of claims creation since
some services are dependent upon other services in calculating a “ticket”. Transportation will not
be billed unless another service is provided/recorded on that day. Personal Care service time may
be reduced if a student was pulled from that time to receive a related service.
Billable Staff
Ensure that everyone who can bill for Medicaid services is marked as such, including bus
drivers. “How to Identify Billable Staff” in this manual.
Parental Consent
(SM)2 tracks parental consent from the SHARS letter as well as from page 7 of the ARD. To
verify if a student has Parental Consent, either run the Parental Consent Report in (SM)2 or
look in the Parental Consent Tracker on the ‘Maintenance’ menu.
Medicaid Rates
Check to make sure the current year Medicaid rates have been entered.
Maintenance – Enter/Edit Medicaid Rates – select Billing Provider – Show Rates
All service records have Diagnosis Codes
Run the Report ‘Missing Diagnosis Codes’ in (SM)2 and correct any tickets.
All service records have Procedure Codes
Run the Report ‘Missing Procedure Codes’ in (SM)2 and correct any tickets.
All students have complete demographic information
Run the Report ‘Missing Demographics’ in (SM)2 and correct any tickets. Demographic
information needs to be changed in SEM, not (SM)2. Once the corrections are made, log back
into (SM)2, click the Refresh SEM Data button, Restart, then log back into (SM)2.
[If your district is fragmented where you have to attach to separate schools in SEM, you will
need to run a Merge Schools first before you will see the changes in (SM)2].
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How to…
Create a Medicaid Claim
Claims are built after the eligibility file (270 file) for that time period has been submitted to TMHP and
the eligibility response file (271 file) has been retrieved and parsed. Claims are created from Services
Rendered ‘tickets’ for eligible students. The following method is used to build claims and create the file
(837) for upload to TMHP.
1. Create and submit the eligibility file (270) following “How to… Identify Medicaid Eligibility in
(SM)2”. If an eligibility list has already been obtained for the claim month, proceed to step 2.
2. Click ‘Claims’ on the ‘Main Menu’.a,b
3. Click ‘(SM)2 Lockout’. a
4. Click ‘Build Claims’. Respond to the message boxes that appear.c
5. Enter the date range for the service records to be generated into claims. Leave the left date field
blank for all services rendered up to the date entered in the right date field. Leave the right field
blank for all services rendered after the date entered in the left field.
6. Indicate whether you want to bypass the blank diagnosis and/or blank procedure check. (If you
decide not to run the check, claims will not be generated from ‘tickets’ without diagnosis and/or
procedure codes.)
7. A box will open for you to verify parental consent for students. Close when done.
8. A box will open for you to verify all billable providers are marked as such. Close when done.
9. If you did not opt to bypass the blank diagnosis and blank procedure check and there are records
with blank diagnosis/procedure codes, the appropriate input screen will open for adjudication of
the missing information. All missing information must be entered before claims will be
generated.
10. Follow remaining prompts to build claim. Once this step is complete, each ticket will now have a
status of NEW.
11. Click ‘Create Claim (837) for Upload’. This file will include all new claims and any that have
previous claims that have been marked to be resubmitted. Once this step is complete, each ticket
will now have a status of IN PROCESS.e,g
12. Click ‘Copy Current Claims (837) File to Local Computer’. Once this step is complete, each
ticket will now have a status of SENT.h
13. See Submit Files to TMHP for file submittal instructions.
The claim has now been submitted to TMHP for billing.
Things to Note:
a.
b.
c.
d.
e.
f.
g.
h.
This process should be performed while everyone is out of (SM)2 to avoid creating tickets that others are actively
creating at the same time. Clicking the SM2 Lockout button will only keep users from logging in once the button is
clicked. It will not log anyone who is already in the system off of the system.
Follow verifications in “Steps to Take Before Creating a Medicaid Claim” before creating claim.
If the ‘Build Claims’ button is not available in step 3 then claims have already been created and the claims file (837) has
already been generated.
Before ever clicking the ‘Delete Current 837 for Rebuilding’, make sure you have not yet clicked on ‘Copy Current
Claims (837) File to Local Computer’. You should contact GG Consulting before clicking the ‘Delete Current 837 for
Rebuilding’ button.
To view the .837 file in HIPAA format click ‘Open Current Claims (837) in Notepad’.
To view any of the existing .837 files click ‘Preview Claims Upload Files (837).
To view the error log generated when creating the 837, click ‘Open Error Log’.
Only continue to step 11 once you are sure you will submit the claim to TMHP.
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Claim Creation Screenshots
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Review/Edit Claims
Once claims have been created from the services rendered ‘tickets’, information related to the ‘tickets’
on the claim cannot be edited, nor can the ‘tickets’ be edited. However, after the ‘.837’ file has been
created, you can choose to delete the file, which will delete all new claims included in the file and
disassociate them from the ‘tickets’. (DO NOT DO THIS IF YOU HAVE ALREADY COPIED
THE FILE TO THE LOCAL WORKSTATION.) The ‘tickets’ can then be edited and the claims
rebuilt. Note: Disassociating ‘tickets’ from the claims will result in deletion of other insurance,
diagnoses and notes associated with the deleted claims.
If claims have already been sent to TMHP and paid, the district will need to go through TMHP to make
any corrections.
The ‘Review Claims’ screen in the Claims menu can be accessed to see the status of all claims in the
system.
Claim Status Descriptions
The status of a claim (i.e., Sent, Paid, Denied) can be viewed on the Review Claims screen. By selecting
the appropriate filters, all claims in the system can be reviewed.
New – a claim was Built but the 837 is not yet created.
Resubmit – claim was marked for resubmission by the district
Waiting for Response – claim is in process awaiting response from TMHP
Processed
Paid – claim was paid by TMHP
Denied – claim was denied payment by TMHP
Rejected – claim was initially rejected by TMHP and not sent for payment
Sent – claim is awaiting response from TMHP.
Resubmitting Claims
Claims that have been processed by TMHP and for which payment has been denied can be resubmitted
after editing by:
1. Click Claims on the ‘Main Menu’.
2. Click ‘Review Claims’. The Review Claims screen will open.
3. Select the student from the dropdown menu.
4. Select the appropriate filter to help find the denied claim.
5. Use the navigation buttons at the bottom of the screen to find the claim to be resubmitted.
6. Click the ‘Resubmit’ button on that ticket or ‘Resubmit Rejected Claims’ at the top of the
screen to resubmit all tickets.
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Review/Edit Claims Screenshots
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How to…
Submit Files to TMHP
The custom CISCO VPN Client for TMHP must be installed on the workstation from which submittals
are made. Eligibility and Medicaid Claims are both sent to TMHP through this process. Have your
TMHP User Name and Password readily available and know the name/date of the file that you are going
to submit.
1. Open the CISCO VPN Client on the local workstation.
2. Connect to TMHP EDI VPN entering your assigned User Name and Password.a,b
3. Open the folder in which the ‘Send’ files are kept as defined in (SM)2 Options. This should be
c:\sm2\send.c
4. Edit - Copy the file just created.
5. Open another SM2 window. (See Step 3.)
6. In the Address box, type ftp://edi.tmhp.com/ and press Enter.
i.
If asked for your User Name and Password it is the same as entered in step 2 above.
7. Open the Dropbox by double-clicking on the icon.
8. Click Edit-Paste to drop the copied file into the dropbox.
9. Close the two windows.
10. Double-Click on the closed padlock in the system tray to open the CISCO VPN Client.
11. Click on the TMHP EDI VPN Connection entry.
12. Click Disconnect.
Things to Note:
a.
b.
c.
You will know that you are connected to the VPN when you see this icon in the lower righthand corner of the desktop.
When you are disconnected, this icon will be “unlocked”.
The Username for TMHP VPN is your Submitter ID.
You can create a shortcut on your desktop to the C:\SM2 folder for quicker access. (Make sure this is where the SM2
folder is located.) The path to this folder should be the same as listed in Options – TMHP File Paths – Path to Local
Computer and Path from Local Computer.
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Submitting Files to TMHP Screenshots
C:/sm2
4
C:\sm2
Send
Receive
C:\sm2
ftp://edi.tmhp.com/dropbox
C:/SM2/Send
C:/SM2/Send
9
9. Copy and paste file
FROM SM2/Send
TO Dropbox
ftp://edi.tmhp.com
6
8
ftp://edi.tmhp.com
ftp://edi.tmhp.com
ftp://edi.tmhp.com
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How to…
Retrieve Files from TMHP
The custom CISCO VPN Client for TMHP must be installed on the workstation from which submittals
are made. Have your TMHP User Name and Password readily available.
1. Open the CISCO VPN Client on the local workstation.
2. Connect to TMHP EDI VPN entering your assigned User Name and Password.
3. Open the folder in which ‘Receive’ files are kept as defined in (SM)2 Options.c
4. Open another incidence of the SM2 folder. (See Step 3.)
5. In the Address box type ftp://edi.tmhp.com/ and press Enter.
6. If asked for your User Name and Password it is the same as entered in step 2.
7. Open the “download” folder by double-clicking the icon.
8. Open the “batch” folder by double-clicking the icon.
9. Click Edit-Select All to highlight all files in the “batch” folder
10. Click Edit-Copy (or Cut if you want to remove the files in the “batch” folder).
11. Return to the window with the ‘receive’ folder open by clicking on it or clicking on the icon for
it on your task bar.
12. Click Edit-Paste. The response files should appear in the window.
13. Close the two windows.
14. Double-Click on the closed padlock in the system tray to open the CISCO VPN Client.
15. Click on the TMHP EDI VPN Connection entry.
16. Click Disconnect.
Things to Note:
a.
b.
c.
You will know that you are connected to the VPN when you see this icon in the lower righthand corner of the desktop.
When you are disconnected, this icon will be “unlocked”.
The Username for TMHP VPN is your Submitter ID.
You can create a shortcut on your desktop to the C:\SM2 folder for quicker access. (Make sure this is where the SM2
folder is located.) The path to this folder should be the same as listed in Options – TMHP File Paths – Path to Local
Computer and Path from Local Computer.
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Retrieve Files from TMHP Screenshots
C:/sm2
4
C:\sm2
Send
Receive
C:\sm2
ftp://edi.tmhp.com/dropbox
C:/SM2/Receive
271
271
C:/SM2/Receive
12.
Copy and paste file
FROM Download/Batch
TO SM2/Receive
ftp://edi.tmhp.com
6
ftp://edi.tmhp.com
ftp://edi.tmhp.com
8
ftp://edi.tmhp.com
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ftp://edi.tmhp.com/download
9
ftp://edi.tmhp.com/download/batch
10
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How to…
Parse Files Received from TMHP
Eligibility and Claims response files are retrieved from the Download/Batch folder at the EDI ftp site
(ftp://edi.tmhp.com). Response files are copied to the c:/SM2/Receive’ (or whichever path is correct for
your workstation) folder of the Medicaid coordinator’s workstation, as defined in the ‘Options’ screen,
for processing by (SM)2.
After the files have been copied to the ‘Receive’ folder:
1. Log into (SM)2 on the server.
2. Click ‘TMHP Response’ on the ‘Main Menu’ to open the ‘Parse TMHP Files’ screen.
3. Click ‘Copy Response Files from Workstation to Server’. Files not previously copied to the
server will be copied to the ‘Receive’ folder on the server.
4. Click ‘Parse Eligibility Response - 271’ to parse any pending eligibility (271) files.
5. Click ‘Parse Claims .REJ file’ to parse any rejected claims (REJ) files.
6. Click ‘Parse Claims Response –27S’ to parse any pending preliminary claims (27S) files.
7. Click ‘Parse Claims Response – 835’ to parse any pending claims (835) files.
8. Click ‘Close’.
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SECTION 4. OPTIONS SCREEN
The Setup Information screen is used to enter/edit information that is used throughout (SM)2. GG
Consulting, LLC will work with district/cooperative staff to complete the program configuration tabs
including the General, TMHP File Paths, Connection Setup (if applicable) and Spell Check tabs. Billing
Providers, Referral Providers, TMHP Data and Bus Routes tabs will be completed based on information
you gather prior to program installation. Below are detailed descriptions of all tabs on the Setup
Information screen.
General Tab
The General tab is used to define database locations, both (SM)2 and Special Education Manager.
Many of the entries will be the same as those found in ‘Options/Directories’ accessed through Special
Education Manager’s File Maintenance screen.
Bypass Parental Consent While Building Claims – ignores parental consent when building a claim.
Bypass Referring Provider Check – ignores the referring provider indicator when a ticket is created.
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Billing Providers Tab
The Billing Providers tab is used to enter information that is included in Medicaid eligibility and claims
submittals. Contact TMHP to let them know that you will be using GG Consulting, LLC’s (SM)2 to file.
You should already have a Billing Provider ID. Since you will be your own billing service you only
need enter information for one billing provider (your district/cooperative) and the Billing Service ID will
be the same as the Billing Provider ID.
1.
2.
3.
4.
5.
6.
7.
8.
9.
August 09
If there is no blank form available, click the ‘Add’ button.
Enter the district/cooperative name in the ‘Billing Provider’ field.
Enter the address information in the appropriate fields.
Enter the ‘Billing Provider/Service ID’, otherwise known as the Texas Provider Identifier or TPI
number, in the respective fields (these will be the same and will have been obtained from
TMHP).
Enter the district ‘National Provider ID’ or NPI number.
Enter the ‘Taxonomy Code’ for the NPI number.
Enter the district Tax ID in the ‘Billing Provider Tax ID’ field.
Enter ‘1’ in the ‘Batch Control’ field to indicate that you will be submitting claims in batch
mode vs. claim by claim (claim by claim is not supported).
Enter the name, telephone number and e-mail address for the Medicaid contact person at your
district/cooperative.
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Referring Providers Tab
Persons responsible for referring students to receive special services (related services) are entered on the
Referring Providers tab on the Setup Information screen. The referring providers entered here will
appear in the list to select from on the Physician Approval/Referring Provider tab of the Student
Information screen (for individual assignments) and the Assign Physician Approvals/Referring
Providers screen (for batch assignments) accessed through the Maintenance screen.
Click on ‘Options’ on the Main Menu.
Select the ‘Referring Providers’ tab.
Click ‘Add.’a
Enter a Provider ID. (This can be any number selected by the district).
Enter the demographics for the Referring Provider (i.e., Last name, first name, etc.). All fields
need to be completed. For Speech Pathologists, the special education office address could be
entered.
6. Repeat steps 3 to 5 for each Referring Provider.
7. Click ‘Close.’
1.
2.
3.
4.
5.
Things to Note:
a. A Referring Provider needs to be entered for a Provider to be able to add them to a student’s record.
b. Once a Referring Provider is entered, they can be accessed from the dropdown list.
c. Referring Providers for Speech Therapy can be Speech Pathologists. Referring Providers for OT and PT are physicians.
Enter a Referring Provider Screenshots
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TMHP Data Tab
The TMHP Data tab includes information related to TMHP communications. For self-filing entities the
data is the same as that entered on the Billing Providers tab. GG Consulting, LLC will assist with
completing this tab.
The Interchange Sender ID is the district’s Submitter ID obtained from TMHP.
TMHP File Paths Tab
The TMHP File Paths tab is used to tell (SM)2 where to put files that will be submitted to TMHP
(Eligibility and Claims files). It is also used to define the folders where TMHP response files will be
located. These paths must be entered for both the server and the Medicaid administrator workstation.
Full read/write access to these folders must be provided. The log file paths (log files and error log files)
are folders on the server where files created during the Eligibility and Claims file generation are placed.
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Connection Setup Tab
The Connection Setup tab is used for dial-up connections for Medicaid filings. Since this will
take special configuration for thin-client modem access on the server, this is not available at
this time.
Spell Check Tab
The Spell Check tab is used to tell (SM)2 where the main and user ‘dictionaries’ are located as
well as where the spell check help system is found. These can be the same as those defined
in Special Education Manager. The default location and file extension for importing text into
(SM)2 are also defined here. GG Consulting, LLC will assist in completing the Spell Check
tab. It looks like this:
Bus Routes Tab
A complete description of the Bus Routes tab can be found in the Transportation section of this
document under ‘How to…Create Bus Routes’.
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How to . . .
Calculate the IEP Ratio for the SHARS Cost Report
In April of each year, the SHARS Cost Report is due to HHSC. This report is usually completed by the
business office in each district. (SM)2 assists with the calculation of the IEP Ratio.
1. Verify the fiscal year dates.
2. Enter the district name.
3. Verify that ‘Use Values from SEM and (SM)2’ is checked.
4. Verify that ‘Eligible Students from (SM)2’ is checked.
5. If the district uses subjects to record Personal Care Services in the ARD, select the subjects
from the dropdown boxes.
6. Click the ‘Get Ratios from SEM/(SM)2’ button. The system will now run the calculations.
Depending on the size of the district, this might take a while. When the calculations are
complete, the Transportation screen will be visible.
7. If the district needs transportation ride calculations, click the ‘Get Ratios from (SM)2.’ If
not, proceed to Step 8. If so, record or print this screen once the transportation rides are
calculated.
8. Click the IEP Ratios tab.
9. The calculations will appear under Calculated from SEM and (SM)2 Data. This screen can be
printed or the numbers can be given to the business department.
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SECTION 5. REPORTS SECTION
(SM)2 reports are designed to monitor services and consolidate TMHP responses. Information displayed on the reports
comes from both (SM)2 and Special Education Manager. Be patient. Often, (SM)2 will be searching through thousands of
records to retrieve the information requested.
List of Reports in (SM)2
Schedule Grid
Snapshot of Provider’s schedule (who is scheduled, was absent, etc.)
Scheduled Services by Staff
Which students are scheduled to a particular Provider
Scheduled Services by Student
Lists the services for a particular student
Transportation Report
Timeline showing when students were present or absent from their bus route for a given month.
Condensed Eligibility Report
Shows the eligibility Start and End Dates for all students meeting report filter criteria.
Eligibility Status Change Report
Allows the printing of eligibility based on criteria: never previously eligible, not eligible per previous submittal, and
eligibility start date after a specified date as imported from the last .271 file.
Medicaid Claims Report
Shows the status of claims as well as the billed amounts. Can also view the 835s on this screen.
TMHP Eligibility Report
Lists all eligibility submission dates and whether student was eligible or not eligible.
Parent Consent Indicated as ‘No’
Lists all students that have “No” marked for parental consent.
Parental Consent Reports
Lists which students for which parental consent has or has not been obtained.
Prescribed Services vs Scheduled/Rendered
Compares the service recommended in the ARD with the amount of that service provided to date.
Maximum Recommended Units Exceeded/Unavailable
Lists whether a Provider has gone over the recommended billable totals according to TMHP.
Medicaid Students w/ Tickets Marked No Consent
Unduplicated list of students who were not included in a claim due to no parental consent.
Missing Demographics
Lists all students missing needed demographic information (e.g., zip code, city, etc.)
Missing Diagnosis Codes
Lists all students missing the required diagnosis code for billing.
Missing Procedure Codes
Lists all students missing the required procedure code for billing.
Missing Referring Providers
Lists all students missing the required diagnosis code for billing.
Missing Start and/or End Times
Lists tickets that are missing either the start or end time on the ticket.
Non-Billable Services Rendered
Lists tickets by criteria indicated on the ticket: Consult, Non-Billable, Provider Non-Billable, or No Parental Consent.
Services by Provider Summary
Lists tickets in SEM by Provider with total number of tickets per student.
Services Rendered by Provider*
Lists all services provided for a give time period by a Provider.
Services Rendered by Service
Lists all services provided for a give time period by a Provider.
Services Rendered by Student
Lists all services provided for a give time period by a Provider.
Staff Assignments
Lists all students assigned to a staff member.
Students w/Eligible Services w/o Tickets
Lists all tickets not included in a claim within a specified date range.
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Report Criteria
All reports follow the same general format.
1. Click on the ‘Reports’ button on the Main Menu. .
2. Highlight the desired report and click ‘Continue’ or double-click the desired report. The Report
Selection Criteria screen will open.
3. When selecting any report, you will always need to tell the system how you want the report to be
compiled.
A. By Student and/or
B. By District and/or
C. By School and/or
D. By Grade and/or
E. By Gender and/or
F. By Ethnicity
4. Click the ‘Select Students’ button.
Things to Note:
a.
b.
c.
Be sure to select the appropriate Enrollment Statuses for the report. The system needs to know what ‘Enrollment Status’
to consider for a student. In (SM)2, students are considered active if their status is Active, Initial, or Transfer. However,
there are times that students who are not active need to be considered in the report.
An SSA can decide which name should appear at the top of a report (i.e, the District Name or the SSA name).
Multiple selections can be made in the list boxes (e.g., By District, By Student, By Campus, By Ethnicity).
Report Criteria Screenshots
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How to Run…
Schedule Grid Report
This report can summarize a Provider’s schedule by:
· Scheduled Services
· Services already provided
· When student was absent from a session
· When Provider was absent from a session
Select ‘Reports’.
Doubleclick on ‘Schedule Grid’.
Enter date range for report.
Check each box that denotes the criteria to
display.
5. Select “Print’ or ‘Preview’.
1.
2.
3.
4.
How to Run…
Scheduled Services by Staff Report
1. Enter the date range for the report. Note: Leave blank to include all dates.
2. Select the services to be included. Leave unchecked to include all services.
3. Select the staff position(s) to be included. Leave unchecked to include all positions. Note: The
Services Providers list box will be filtered by the selected staff positions.
4. Select the Providers to be included in the report. Leave unchecked to include all listed providers.
5. Click the ‘Print’ or ‘Preview’ button.
How to Run…
Scheduled Services by Student Report
1. Enter the date range for the report. Note: Leave blank to include all dates.
2. Select the services to be included. Leave unchecked to include all services.
3. Select the staff position(s) to be included. Leave unchecked to include all positions.
Note: The Services Providers list box will be filtered by the selected staff positions.
4. Select the Providers to be included in the report. Leave unchecked to include all
providers listed.
5. Click the ‘Print’ or ‘Preview’ button.
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How to Run…
Transportation Report
1. Enter the month for the report.
2. Select the services to be displayed. Note: More than one option can be selected.
3. Click the ‘Print’ or ‘Preview’ button.
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How to Run…
The Parental Consent Report
This report creates an alphabetical listing of all students with or without Parental Consent.
To view individual student’s, go to the Parent Consent Tracker.
Go to ‘Reports’.
Doubleclick on Parental Consent Report.
Choose filter (by District, by School, by Student).
Choose dates.
The ‘Start Date’ refers to the actual date of consent given by the parent obtained from either the
SHARS letter or Page 7 of the ARD. Since consent is generally for a calendar year, this date may
need to be a year earlier than “today’s” date since some of the current parental consents were
obtained up to a year earlier.
5. Check whether to show students ‘With Consent’ or ‘Without Consent’.
6. Select ‘Print’ or ‘Preview’.
1.
2.
3.
4.
How to Run…
Parent Consent Indicted as ‘No’
This report lists all students, Medicaid eligible or not, who have ‘NO’ marked for Parental Consent. To
view individual students, go to the Parent Consent Tracker.
1.
2.
3.
4.
5.
6.
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Go to ‘Reports’.
DoubleClick on ‘Parent Consent Indicated as ‘No’.
Choose the appropriate filter (by District, by School, by Student).
Input the date for all ‘No’ answers occurring after a certain date.
Check whether or not to limit the list to students with Medicaid numbers.
Select ‘Print’ or ‘Preview’.
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How to Run…
Prescribed Services vs. Scheduled/Rendered Report
1. Enter the date range for the report.
2. Select the services to be included in the report. If all services are to be included, leave
unchecked.
3. Indicate whether you want details for the scheduled and/or rendered services. Details try to
compare actual prescribed times to that provided in common terms (e.g. minutes per week).
4. Select the service providers to be included in the report. If all providers are to be included, leave
unchecked.
5. Click the ‘Print’ or ‘Preview’ button. Be patient. This report may be retrieving several records
from both Special Education Manager and (SM)2.
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How to Run…
Condensed Eligibility Report
This is the preferred report to run to see if a student is eligible for Medicaid.
1. Enter the date range for the request or leave blank for all dates.
Most students will have the same end date. This date indicates the last day that eligibility was
updated in (SM)2 by the Medicaid administrator in the district.
Sample Report
How to Run…
Eligibility Status Change Report
This report gives the change in eligibility for students after a .271 has been parsed.
1. Click Reports on the (SM)2 Main Menu.
2. Click ‘Eligibility Status Change Report’ under TMHP Reports.
3. Select the date range.
4. Select the desired criteria:
a. Never previously eligible – student has never been eligible for Medicaid.
b. Not eligible per Previous Submittal – student was not eligible in the last submission.
c. Eligibility Start Date After Specified Date – eligibility began for a student after a specific
date.
5. Click the ‘Print’
or ‘Preview’ button.
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How to Run…
Medicaid Claims Report
1. Enter the date range for the report.
2. Select services to be included in the report.
3. Select service provider positions to be included in the report. Note: The Service Provider list
will be filtered by the positions selected here.
4. Select the service providers to be included in the report.
5. Indicate whether detailed TMHP responses are to be included.
6. Indicate which claims are to be included (i.e. Paid, Denied, In Process, or New).
i.
Paid – the 835 has been parsed
ii.
Denied – TMHP has denied the claim
iii.
Sent – claim has been sent to TMHP and district is waiting for 835
iv.
In Process – claim has been built and 837 has been created
v.
New – claim has been built but has not been included in an 837
7. If available, indicate if dollar/billed amounts should be shown on report.a
8. Click the ‘Print’ or ‘Preview’ button.
Things to Note:
a. Step 7, Show Billed amounts, is only available to users with access levels above that which is indicated
defined on the Options screen. Users with access levels below that defined on the Option screen will not see
this check box or the amounts in the report.
b. To view the contents of a specific 835, leave all boxes on this screen blank but check the .835 and Show
Billed Amounts (7).
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How to Run…
TMHP Eligibility Report
This report will list each eligibility submission and whether or not the student was eligible.
1. Enter the date range for which eligibility is to be reported. Note: All TMHP responses will be
included.
2. Select whether you want eligible or ineligible students (or both).
3. Click the ‘Print’ or ‘Preview’ button.
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How to Run…
Maximum Recommended Units Exceeded/Unavailable
This report should be run before a claim is created. The report will display which tickets will result in
billing for more units than Medicaid recommends. If the provider is billing over the recommended time,
they should put the reason for the need for additional services in the Session Notes. However, this report
will also help identify careless errors made while creating tickets such as putting 11:30pm when the
provider intended to type 11:30 AM (which resulted in an excessive number of units to bill).
1. Enter the desired date range to view or leave the date range blank. Remember that this report will
show individual tickets so the user may want to break the dates into smaller segments for
viewing.
2. Select the appropriate filter (or no filter at all for all services, staff positions, and providers.)
Sample report
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How to Run…
Medicaid Students w/Tickets Marked No Consent
This report will display an unduplicated list of students who have tickets that were not included in a
claim because they had no Parental Consent at the time the claim was created for that date range.
1. Enter the date range of the date of the tickets that are marked No Parental Consent.
If the parental consent is obtained for these tickets and marked as such in Maintenance – Parental
Consent Tracker, they will be included if another claim is built for that date range.
How to Run…
Missing Demographics
This report will list students that are missing required demographic information. If these are not fixed in
SEM, TMHP will reject the claim for these students.
Sample Report
Note that these students are missing a zip code.
These claims will be rejected if sent to TMHP. The
zip code needs to be added into SEM to fix.
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How to Run…
Missing Diagnosis Codes
All tickets must have a diagnosis code before they will be included in a claim. This report will show
which tickets are missing diagnosis codes.
Enter a date range for the ticket or leave the date range blank for all tickets in the system.
Sample Report
How to Run…
Missing Procedure Codes
All tickets must have a procedure code before they will be included in a claim. This report will show
which tickets are missing procedure codes.
Enter a date range for the ticket or leave the date range blank for all tickets in the system.
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How to Run…
Missing Referring Providers
This report lists which tickets are missing a referring provider. All tickets for Speech Therapy,
Occupational Therapy, and Physical Therapy that are submitted to Medicaid should have a Referring
Provider. Unlike missing diagnosis and procedure codes, if the ticket has no referring provider indicated,
it will still be submitted to Medicaid. These should be corrected before the ticket is included in a claim.
This report will not include consult and nonbillable tickets since these are not submitted to Medicaid.
The user can also filter by only those students who have a Medicaid ID since only those tickets that are
Medicaid eligible need a Referring Provider.
Enter the date range for the tickets.
How to Run…
Missing Start and/or End Times
This report lists which tickets are missing the required start or end time.
Enter the date range for the tickets or leave blank for all tickets.
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How to Run…
Non-Billable Services Rendered Report
This report allows the administrator to print a list of tickets that were not included in a claim as
determined by the criteria selected/indicated on the ticket: Consult, Non-Billable, Provider Non-Billable,
or No Parental Consent. If the latter two are changed in (SM)2, the ticket could be billed the next time a
claim is built.
Enter the date range of the tickets.
Select the criteria desired that is indicated on the ticket.
Choose ‘Students with Medicaid numbers only’ for those tickets for students with a Medicaid ID.
How to Run…
Services by Provider Summary
This report lists how many tickets each provider has per student.
Sample Report
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How to Run…
Services Rendered by Provider Report
1. Enter the date range for the report. Note: Leave blank to include all dates.
2. Select the services to be included. Leave unchecked to include all services.
3. Select the staff position(s) to be included. Leave unchecked to include all positions. Note: The
Services Providers list box will be filtered by the selected staff positions.
4. Select the Providers to be included in the report. Leave unchecked to include all listed providers.
5. Indicate whether to include or not to include services associated with Medicaid claims.
6. Click the ‘Print’ or ‘Preview’ button.
Services Rendered by Student Report
1. Enter the date range for the report. Note: Leave blank to include all dates.
2. Select the services to be included. Leave unchecked to include all services.
3. Select the staff position(s) to be included. Leave unchecked to include all positions.
Note: The Services Providers list box will be filtered by the selected staff positions.
4. Select the Providers to be included in the report. Leave unchecked to include all listed
providers.
5. Indicate whether to include or not to include services associated with Medicaid claims.
6. Click the ‘Print’ or ‘Preview’ button.
Services Rendered by Service Report
1. Enter the date range for the report. Note: Leave blank to include all dates.
2. Select the services to be included. Leave unchecked to include all services.
3. Select the staff position(s) to be included. Leave unchecked to include all positions. Note: The
Services Providers list box will be filtered by the selected staff positions.
4. Select the Providers to be included in the report. Leave unchecked to include all listed providers.
5. Indicate whether to include or not to include services associated with Medicaid claims.
6. Click the ‘Print’ or ‘Preview’ button.
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How to Run…
Students with Eligible Services and No Tickets Report
This report will look at the ARD in SEM and see which services are indicated. Then it will look
at (SM)2 and determine whether or not there are tickets in the date range.
Sample Report
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APPENDIX A – BEGINNING OF THE YEAR in (SM)2
List of Tasks
1. Verify that new staff are marked as billable. Go into ‘Staff Positions Reimbursement Defaults’
first, then Staff Access.
2. Verify the Access Type of any new staff entered into SEM, ‘Staff Access and Reimbursement
List’.
a. For (SM)2 Access Type, all Providers will need to be reassigned to students either in the
Staff Assignments Wizard or Maintenance. You can delete all current assignments by going
to ‘Beginning of Year Preparation’ in Maintenance.
b. For SEM Access Type, verify in SEM that the staff person is assigned to the correct campus.
3. If the district tracks transportation,
b. Edit the Bus Routes as necessary under ‘Options’,
c. Clear current Bus Assignments in ‘Beginning of Year Preparation’ in Maintenance.
d. Reassign students to bus routes in either ‘Staff Assignments Wizard’ or Maintenance.
4. ‘Enter/Edit Medicaid Rates’ for the current school year. If they are the same as the previous
year, you can ‘Import Rates from Previous Year’.
5. Add any new Referring Providers to (SM)2 under ‘Options’.
6. ‘Set School Calendars’ for this school year in Maintenance.
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