Service Authorization Information Specific to Skilled Respite under

Report
INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT
Service Authorization
Process for Technology
Assisted Waiver Skilled
Respite (Service Types
0960)
Presented by: KePRO
1
Methods of Submission Service Authorization
Requests to KePRO
•
•
•
•
•
KePRO accepts service authorization (srv auth) requests through direct
data entry (DDE), fax and phone.
Submitting through DDE puts the request in the worker queue
immediately; faxes are entered by the administrative staff in the order
received.
For direct data entry requests, providers must use Atrezzo Connect
Provider Portal.
For DDE submissions, service authorization checklists may be accessed
on KePRO’s website to assist the provider in assuring specific information
is included with each request.
To access Atrezzo Connect on KePRO’s website, go to
http://dmas.kepro.com.
2
2
Methods of Submission Service Authorization
Requests to KePRO
•
•
Please note that for Alzheimer's Assisted Living Waiver, all requests
must be submitted via KePRO’s Atrezzo Connect System
To access Atrezzo Connect on KePRO’s website, go to
http://dmas.kepro.com.
•
Provider registration is required to use Atrezzo Connect.
•
The registration process for providers happens immediately on-line
•
From http://dmas.kepro.com, providers not already registered with
Atrezzo Connect may click on “Register” to be prompted through the
registration process. Newly registering providers will need their 10digit National Provider Identification (NPI) number and their most
recent remittance advice date for YTD 1099 amount.
•
The Atrezzo Connect User Guide is available at
http://dmas.kepro.com : Click on the Training tab, then the General
tab.
3
Service Authorization Requests: Contact
Information for KePRO/ DMAS Provider Information
•
Providers with questions about KePRO’s Atrezzo Connect Provider Portal
may contact KePRO by email at [email protected]
•
For service authorization questions, providers may contact KePRO at
[email protected]
•
KePRO may also be reached by phone at 1-888-827-2884, or via fax at 1877-OKBYFAX or 1-877-652-9329.
4
Service Authorization Information Specific to Skilled
Respite under Technology Assisted Waiver
• The Technology Assisted Waiver (TW)
provides medically appropriate and cost
effective coverage of services necessary
to maintain individuals in the community,
who would otherwise remain in hospitals
or specialized care facilities.
5
Service Authorization Information Specific to Skilled
Respite under Technology Assisted Waiver
•
•
•
•
Services Offered in Tech Waiver and
authorized by DMAS:
Skilled Private Duty Nursing (PDN)
Personal Care Services- Agency Directed
(Adults Only)
Transition Services
Congregate Nursing/Respite Services
6
Service Authorization Information Specific to Skilled
Respite under Technology Assisted Waiver
•
•
•
•
•
Services Offered in Tech Waiver and
authorized by KePRO:
Skilled Respite Care
Assistive Technology
Assistive Technology Maintenance
Environmental Modifications
Environmental Modification Maintenance
7
Service Authorization Information Specific to Skilled
Respite under Technology Assisted Waiver
Service Limits:
• Maximum of 360 hours may be authorized per
calendar year
• The Authorization will span for 24 months
Service Type:
• 0960-Technology Assisted Waiver
Procedure Code:
• S9125 TE Agency Directed LPN Skilled
Nursing
• S9125 TD Agency Directed RN Skilled Nursing
8
Service Authorization Information Specific to Skilled
Respite under Technology Assisted Waiver
Eligible Members for TW include individuals who:
•
•
•
Have Medicaid FFS
Are enrolled in TW prior to enrollment in TW respite as
TW respite is not a stand alone service
NOTE**Individual coverage shall not be provided for
individuals who reside in board and care facilities,
inpatients in general acute care hospitals, skilled or
intermediate nursing facilities, or intermediate care
facilities for the mentally retarded, specialized care, or
long stay hospital
9
Service Authorization Information Specific to Skilled
Respite under Technology Assisted Waiver
Timeliness Requirements for Submission:
•
•
•
Providers must submit documentation to KePRO within
10 business days of initiation of care
If request is not submitted within 10 business days, the
service must be authorized beginning with the date the
information was received by KePRO
If additional information is needed from the provider, the
case is pended for 5 business days
10
Service Authorization Information Specific to Skilled
Respite under Technology Assisted Waiver
Required Forms and Documentation
•
•
Requests can be submitted to KePRO by fax, phone,
and/or direct data entry
If submitting by fax, please include:
•
•
DMAS 98
Completed CMS 485 and/or verbal order signed and
dated by physician
11
Service Authorization Information Specific to Skilled
Respite under Technology Assisted Waiver
Required Forms and Documentation
(cont)
•
•
•
•
If submitting by Atrezzo Portal, please:
Complete Tech Waiver Questionnaire
Completed CMS 485 and/or verbal order signed
and dated by physician
NOTE**The information submitted must include
clear documentation of need for the amount of
Respite Care
12
Service Authorization Information Specific to Skilled
Respite under Technology Assisted Waiver
Transferring Respite Services from one
agency to another:
• Transferring provider must submit DMAS
225 to KePRO with the effective
discharge date
• The new provider will need to submit a
request for services
13
Service Authorization Information Specific to Skilled
Respite under Technology Assisted Waiver
Criteria:
•
•
•
•
Must be an unpaid Primary Caregiver
Service may be provided in the member’s
primary residence or to assist with
transportation to medical appointments
Must be enrolled in the TW by DMAS before
processing respite service request
Authorization for TW respite is contingent upon
the approval for PDN by DMAS
14
General Information for All Service Authorization
Submissions
•
•
•
•
•
•
•
There are no automatic renewals of service authorizations.
Providers must submit requests for continuation of care needs, with
supporting documentation, prior to the expiration of the current
authorization.
Providers must verify member eligibility prior to submitting the request.
Authorizations will not be granted for periods of member or provider
ineligibility.
Requests will be rejected if required demographic information is absent.
Providers should take advantage of KePRO’s web based
checklists/information sheets for the services(s) being requested. These
sheets provide helpful information to enable providers to submit
information relevant to the services being requested.
Providers must submit a service authorization request under the
appropriate service type. Service authorization requests cannot be bundled
under one service type if the service types are different.
15
VIRGINIA MEDICAID WEB PORTAL
•
•
•
•
•
DMAS offers a web-based Internet option to access information regarding
Medicaid or FAMIS member eligibility, claims status, check status, service
limits, service authorizations, and electronic copies of remittance advices.
Providers must register through the Virginia Medicaid Web Portal in order
to access this information. The Virginia Medicaid Web Portal can be
accessed by going to: www.virginiamedicaid.dmas.virginia.gov.
If you have any questions regarding the Virginia Medicaid Web Portal,
please contact the Xerox State Healthcare Web Portal Support Helpdesk,
toll free, at 1-866-352-0496 from 8:00 a.m. to 5:00 p.m. Monday through
Friday, except holidays.
The MediCall audio response system provides similar information and can
be accessed by calling 1-800-884-9730 or 1-800-772-9996. Both options
are available at no cost to the provider.
Providers may also access service authorization information including
status via KePRO’s Provider Portal at http://dmas.kepro.com.
16
ELIGIBILITY VENDORS: How to check for Member
Eligibility
•
•
•
DMAS has contracts with the following eligibility verification vendors
offering internet real-time, batch and/or integrated platforms.
Eligibility details such as eligibility status, third party liability, and service
limits for many service types and procedures are available.
Contact information for each of the vendors is listed below:
– Passport Health Communications, Inc.
• www.passporthealth.com, [email protected]
• Telephone: 1 (888) 661-5657
– SIEMENS Medical Solutions – Health Services
• Foundation Enterprise Systems/HDX
• www.hdx.com
• Telephone: 1 (610) 219-2322
– Emdeon
• www.emdeon.com
• Telephone: 1 (877) 363-3666
17
DMAS Helpline Information
• The “HELPLINE” is available to answer questions Monday through
Friday from 8:00 a.m. to 5:00 p.m., except on holidays.
•
The “HELPLINE” numbers are:
– 1-804-786-6273
– 1-800-552-8627
Richmond area and out-of-state long distance
All other areas (in-state, toll-free long distance)
• Please remember that the “HELPLINE” is for provider use only.
• Please have your Medicaid Provider Identification Number
available when you call.
18
Provider Manual/Medicaid Memorandums
•
Technology Assisted Waiver Services Manual
•
DMAS publishes electronic and printable copies of its Provider Manuals
and Medicaid Memoranda on the DMAS Web Portal at
https://www.virginiamedicaid.dmas.virginia.gov/wps/portal.
•
This link opens up a page that contains all of the various communications
to providers, including Provider Manuals and Medicaid Memoranda.
•
The Internet is the most efficient means to receive and review current
provider information.
•
If you do not have access to the Internet or would like a paper copy of a
manual, you can order it by contacting:
– Commonwealth-Martin at 1-804-780-0076. A fee will be charged for
the printing and mailing of the manual updates that are requested.
19
INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT
Questions???
20

similar documents