Overview of Client Forms for MOHSAIC Entry

Providers entering on-line information are not required to fill out paper forms but must have documentation of the information submitted to the Missouri Health Strategic Architectures and Information Cooperative (MOHSAIC) in the client files for quality assurance (QA) review.

Access the Patient History, Screening Report, Breast Diagnosis and Treatment, Cervical Diagnosis and Treatment, and Client Navigation forms online. Alternatively, call 866-726-9926.

All forms contain a ‘Comment’ section at the bottom of the form. This is used for additional notes on the client or procedures entered by the provider or DHSS staff. Explanations should be kept brief as space is limited. Comments are not mandatory, but helpful to retain information not covered in the form. Providers must submit completed client forms within 60 days of service.

If waiting for insurance reimbursement/approval forms, do not submit complete billing until the amount insurance paid is available. See page 9.3 for Insurance Guidelines.

Green Patient History Form

The Patient History form (green form, pages 10.8-.9) shall be completed by each client at the initial screening visit and at every annual screening thereafter. The provider shall enter the green history form into MOHSAIC when reporting the initial screening visit and update the information each year, as needed. Enter the green history form into MOHSAIC before entering any other form.

Blue Screening Report

A completed Screening Report form (blue form, pages 10.10-.11) shall be submitted at the initial, rescreen, and annual screening for all clients participating in SMHW. Document the first mammogram a client receives on the screening report.

Purple Breast Diagnosis and Treatment Form

The Breast Diagnosis and Treatment form (purple form, pages 10.12-.13) shall be fully completed for all clients with abnormal breast cancer screening results that require further diagnostic procedures and/or treatment. If needed, diagnostic service(s), date of service(s), results of diagnostic service(s), final diagnosis, and treatment (date, type and place) are also required on the purple form. This information is crucial for the successful follow-up and/or treatment of all clients with abnormal screening results.

Yellow Cervical Diagnosis and Treatment Form

The cervical Diagnosis and Treatment form (yellow form, pages 10.14-.15) shall be fully completed for all clients with abnormal cervical cancer screening results that require further diagnostic procedures and/or treatment. If needed, diagnostic service(s), date of service(s), results of diagnostic service(s), final diagnosis, and treatment (date, type, and place) are also required on the yellow form. This information is crucial for the successful follow-up and/or treatment of all clients with abnormal screening results.

MOHSAIC Access

MOHSAIC is an online data system used to collect and manage client service records for the SMHW and WISEWOMAN programs.

MOHSAIC also tracks funding allocations and expenditures and is linked to the Statewide Advantage for Missouri (SAM II) accounting system for reimbursing providers. Prior to reimbursement, SMHW and WISEWOMAN staff review all submitted forms to ensure client services meet program standards.

SMHW must submit Minimum Data Elements (MDE) reports to the Centers for Disease Control and Prevention (CDC) from the MOHSAIC reporting data forms.

How to apply for access to MOHSAIC

To apply for access to MOHSAIC, applicants will need to follow the instructions on the following pages.

MOHSAIC Access Instructions

Navigating MOHSAIC

Lesson 1: The CLIENT

This is for the Provider or MOHSAIC Customer. In this lesson, learn how to:

• Develop a new password
• Log onto the SMHW application
• Search for existing clients
• View Medicaid information
• Register new clients

Steps to Access the MOHSAIC Application and Log onto the SMHW Application

Log-in Process

Open the Internet browser and enter the Web address on the address line: https://healthapps.dhss.mo.gov/smhw/.

• If this is the first time to login, a password must be established:
  • Use the username and assigned password provided to you by e-mail from SMHW, when approved. User name is usually the first five letters of last name and first name initial. Initial password is first and last name initials and last four digits of SSN.
  • Click on ‘Change Password.’

  • If you do not login to MOHSAIC for 30 days, the system will ‘lock out.’ You must call the ITSD

    Help Desk at 800-347-0887 to unlock and enter new password.

  • After a password is established, the program will ask to change your password every 30 to 60 days. This can be numbers, letters, or a combination, as desired. Password requires six (6) to eight (8) characters and one numeric value.
• Once logged in, your agency name will appear and stay constant throughout the application.
• Click the ‘Login’ button to proceed.

Application Instructions