Determine Contract Eligibility - DCE

Determine Contract Eligibility (DCE) is a new functionality of the CM and CCM Administration Modules. Through DCE employees will be able to verify the member’s contract eligibility directly from the Admin Module. DCE will also populate contract information into a case (including eligibility), significantly reducing the amount of data that must be keyed manually.

This web page is the temporary location of DCE's training materials. Click on the icons or links on the right column of the table below to access the materials.

The training manual is a PDF document that will guide you through various screens added by DCE to the Admin Module. Navigating through the new screens is fairly simple and intuitive since some of the required steps are already part of your daily work.

For your convenience, links to Policies and Procedures, as well as Exceptions and Job Aids, have been included on this page.

***CLICK HERE TO LEARN ABOUT RECENT UPDATES***

Learning Objectives
Course Materials
  • Populate information into a case and key a referral using DCE.
  • Verify eligibility using the Admin Module.
  • Add an eligibility check to the Admin Module.
  • View eligibility snapshots.

Stand-alone manual

Procedures:

DCE Eligibility Procedures

DCE procedures are the same for Case Management, CBU, CCP, Health Advocates and IRA.

Exceptions:

Reviewing Eligibility Snapshots

Reviewing the Billing Status Code

Checking for Prior Coverage

Reviewing MNSKEY for Benefits and/or Pre-Existing Requirements

Reviewing SUBM for Medicare Coverage

Reviewing the YNTT for Dollar Maximums

Reviewing the EM Screen for Appeal Information

Reviewing OBN or QUA for Pre-Existing Requirements

Reviewing NASCO for Medicare Information

Job Aids:

Verifying Eligibility in NASCO When the Admin Module is Down

Verifying Eligibility in PRISM When the Admin Module is Down

Verifying Eligibility in Web-DENIS When 3270 is Down

Updates, issues and resolutions:

Click HERE to access information about scheduled updates for DCE as well as known issues and resolutions.