Revision 19-7; Effective June 3, 2019
 

The Mismatched Individual Service Plan (ISP) and Medical Necessity (MN) End Dates report shows ISP end dates with MN end dates that do not match.

 

Report Fields

PCN – The member's nine-digit Medicaid number.

Name – The member's last name, first name and middle initial (when provided).

SG – The Service Authorization System Online (SASO) Service Group (SG). The STAR+PLUS SG is 19.

SC – The SASO Service Code (SC). The STAR+PLUS SC is 12. SC 13 should not appear on this report; if SC 13 does appear, disregard the line item.

ISP Begin Date – The begin date of the last ISP registered in SASO.

ISP End Date – The end date of the last ISP registered in SASO.

MN Begin Date – The begin date of the last MN registered in SASO.

MN End Date – The end date of the last MN registered in SASO.

MN – The approval or denial of the MN referenced in the MN begin/end date:

  • "Y" means the MN was approved.
  • "N" means the MN was denied.

RG – The three-digit Risk Group number.

Enroll Month – The most current enrollment month at the time of the report.

Plan – The two-digit managed care organization (MCO) plan code.

TP – The member’s two-digit Medicaid Type Program.

 

Program Support Unit (PSU) Entry Fields

Comments (Date and Action taken) – PSU staff must enter appropriate comments after researching the ISP/MN end dates, which should match. For example, an ISP ends on May 31, 2019, and the MN ends on April 30, 2019. PSU staff must research the reason for the mismatch.

There may be valid situations in which the two dates will not match. For example, a Money Follows the Person (MFP) case has an ISP registered for one day. The MN will not match the one-day registration in this case.

Mismatched ISP and MN End Dates is a periodic report sent on an as-needed basis. PSU staff are required to research, resolve and respond to the requestor within 14 days of receipt.

Note: SASO files used by Program Enrollment Support (PES) staff to produce this report are a snapshot in time and may not reflect registrations at the point of receipt.