Managed Care Entity System Companion Guide

MCE System Companion Guide

Change Control Table

Appendices

• Appendix A: Acronyms, Definitions and Data Elements
• Appendix B: Frequently Asked Questions
• Appendix C: Code Sets
• Appendix D: MCE Onboarding and Encounter Testing – How to be an MCE
• Appendix E: EDI Test Plan and File Exchange Schedule
• Appendix F: System Generated Files and Reports
• Appendix G: Helpful Websites
• Appendix H: 820 File – FI to MCO
• Appendix I: MCE SCG Links to Other Documents
• Appendix J: Medicaid MMIS Claims and Encounter Inquiry Procedure

Behavioral Health and Dental

• Behavioral Health and Dental SMO Non-EDI File Layout
• Dental Plan Comparison Chart
• Behavioral Health Provider Types and Specialties

File Layout

• Non-EDI File Layout
• Behavioral Health and SMO Non-EDI File Layout
• Transportation Non-EDI File Layout

Forms

• EDI Annual Certification of Electronic Files Form
• Annual EDI Cover Letter
• Encounter Data Certification Form
• EDI Transmission Research Request Form - Gainwell
• MCE Registration To Do List
• MCE Testing Protocol
• MCO Registration Packet
• MES Inquiry Request Form
• TPL Links to Update Recipient Insurance

Tables

• Edits Comprehensive, Repairable and Non-Repairable
• SCG MCE Tables