KEPRO Provider Manual Appendix B

Transcription

1 KEPRO Provider Manual Appendix B Updated August 2016 Table of Contents General Instructions for Contact for Service Notification (CFSN)... 2 General Instructions for Prior Authorizations (PA)... 8 General Instructions for Initial Registrations General Instructions for Continued Stay Reviews (CSR) General Instructions for Discharges... 29

2 General Instructions - KEPRO CareConnection Contact for Service Notification (CFSN) *These instructions provide the general process for submitting a Contact for Service Notifications. For service specific directions please see Appendix C. The Contact for Service Notification (CFSN) is required if the member must wait for service one or more days. Submit a CFSN to KEPRO at the point that a member first contacts the provider or is referred for service. A CFSN is not required if members are assigned to a Case Manager the same day that they are referred. If members are assigned to a service within 24 hours, with no waiting time, the provider may submit an Initial Registration or a Prior Authorization request (as appropriate), without first submitting a Contact for Service Notification. How to Submit a Contact for Service Notification (CFSN) in CareConnection For Members With an active MaineCare number 1. Begin the CFSN on the New Request page. Enter in the MaineCare number in the Member ID box. Enter in one other piece of identifying information. Click Verify and then click Add Member. 2. The Member Information Page - This page will auto-populate for members with a MaineCare number. You are not able to edit this information, as it is a direct feed from MaineCare. Click Save and Continue. 2

3 3. Guardian Information Page - Please complete this page for children and for adults who are under guardianship. Click Save and Continue. 4. Administrative Page - a. Choose Contact For Service Notification for the Authorization Type. b. The Start Date for Current Authorization Request must be the date of the member s first contact for service. c. Choose Routine in the dropdown menu for This Request is. d. Choose the appropriate Review Type and Category of Service. e. The Date of Referral is the date the member was first referred to your agency. f. Select the Location at Time of Referral g. Click Save and Continue. 3

4 5. Requesting Agency Page - Fill out all of the sections in red, and click Yes for Is this agency/individual the treating provider? Click Save and Continue. 6. Services Requested Page - Click on the Add New Procedure Request link. a. Choose the procedure code for the appropriate service. b. Choose the Frequency of Services. c. Choose the NPI number from Provider Billing ID box. d. Your service length and units will automatically populate. You may generate the end date automatically by clicking in the Service Length box and hitting the Tab key on your keyboard. Click Save to add the service code. e. Click Save and Continue. 4

5 7. Submit to KEPRO Page - Click the blue Submit to KEPRO button to submit your CFSN. For Grant Funded Members or Members without a MaineCare number 1. Begin the CFSN on the New Request page. Type a 0 (zero) in the Member ID box. Enter in one other piece of identifying information. Click Verify and then click Add Member. 2. Member Information Page - Fill out all sections in red. Fill out the rest of the page if you have the information. Click Save and Continue. 5

6 3. Guardian Information Page - Please complete this page for children and for adults who are under guardianship. Click Save and Continue. 4. Administrative Page - a. Choose Initial Courtesy Review for the Authorization Type. b. The Start Date for Current Authorization Request must be the date of the member s first contact for service. c. Choose Routine in the dropdown menu for This Request is. d. Choose the appropriate Review Type (choose Grant Funded Adult Services to add member to Grant Funded Wait List) and Category of Service. e. The Date of Referral is the date the member was first referred to your agency. f. Select the Location at Time of Referral g. Click Save and Continue. 6

7 5. Requesting Agency Page - Fill out all of the sections in red, and click Yes for Is this agency/individual the treating provider? Click Save and Continue. 6. Services Requested Page - Click on the Add New Procedure Request link. a. Choose the procedure code for Non-MaineCare Contact for Service Notification containing the appropriate service. b. Choose the Frequency of Services. c. Choose the Provider Billing ID. d. Your service length and units will automatically populate. You may generate the end date automatically by clicking in the Service Length box and hitting the Tab key on your keyboard. Click Save to add the service code. e. Click Save and Continue. 7. Submit to KEPRO Page - Click the blue Submit to KEPRO button to submit your CFSN. 7

8 Removing a Member from a Wait List If the member is removed from the providers wait list without starting services, the provider will discharge the appropriate Contact for Service Notification (follow discharge process described later in this manual). When the member is assigned to the providers service, the provider submits an Initial Registration or a Prior Authorization request (as appropriate). This will remove the member from the wait list report. The Contact for Service Notification does not need to be discharged, with the exception of GRANT FUNDED Contact for Service Notifications. GRANT FUNDED Prior Authorizations or Registrations will not negate a GRANT FUNDED Contact for Service Notification, therefore it must be discharged in CareConnection so the member will be removed from the GRANT FUNDED wait list. General Instructions - KEPRO CareConnection 8

9 Initial Registration *These instructions provide the general process for submitting Registrations. For service specific directions please see Appendix C. How to Submit a Registration in CareConnection 1. For members With an active MaineCare number: Begin the Registration on the New Request page. Enter in the MaineCare number in the Member ID box. Enter in one other piece of identifying information. Click Verify and then click Add Member. 2. For Grant Funded Members or Members Without a MaineCare number: For Grant Funded requests or Non-MaineCare requests, click New Request. Enter a zero (0) for the Member ID and fill in one other piece of identifying information. Click verify then Add Member at the bottom of the screen to start a new review. 3. The Member Information Page - This page will auto-populate for members with a MaineCare number. You are not able to edit this information, as it is a direct feed from MaineCare. Click Save and Continue. 9

10 4. Guardian Information Page - Please complete this page for children and for adults who are under guardianship. Click Save and Continue. 5. Administrative Page a. Choose Prior Authorization for the Authorization Type. b. Enter in the Start date needed for the authorization period. Please note: Initial Registrations must be submitted within fifteen (15) calendar days of the needed start date. The 15 day window does not apply to Hospitals, PNMI residential or crisis units. Hospitals must submit reviews within 72 hours of starting services, and PNMIs/ Crisis Units must submit reviews within 24 hours of starting services. c. Choose Routine in the dropdown menu for This Request is. d. Choose the appropriate Review Type and Category of Service e. Enter in Date of Referral, Location at time of Referral, Date Case Worker Assigned, and Date Seen Face to Face as applicable to the service. Please see Appendix C for service specific instructions. f. Click Save and Continue. 10

11 6. Requesting Agency Page - Fill out all of the sections in red, and click Yes for Is this agency/individual the treating provider? Click Save and Continue. 7. Diagnostic Assessment Page Enter in the Date of Diagnostic Assessment and the Primary Diagnosis. Fill in the remaining fields as appropriate to demonstrate eligibility for the service you are providing. Click Save and Continue. 8. Services Requested Page a. Click on the Add New Procedure Request link. b. Choose the procedure code for the appropriate service. c. Choose the Frequency of Services. d. Choose the NPI number from Provider Billing ID box. 11

12 e. Your service length and units will automatically populate. You may generate the end date automatically by clicking in the Service Length box and hitting the tab key on your keyboard. f. Repeat steps a through e for every service needed f. Click Save and Continue. 9. Additional Information Page It is recommended that this section be used to provide clinical rationale for the services requested. Information should be relevant for purposes of utilization review, highlighting the ways in which the member continues to meet eligibility requirements for the services requested. Click Save and Continue when complete. 10. Document Upload Page To upload a supporting document to your case, select the document type, click browse and then search your computer for the saved document. Once you have located the document, double click to add it and then click the attach button. Please note: Document upload does not replace the requirement to enter clinical data in to CareConnection. Incomplete reviews may be administratively closed. For more information on Document Upload please visit Appendix A of the Provider Manual. 12

13 11. Submit to KEPRO Page Before submission, you may print the treatment plan by pressing the blue Print Treatment Plan button. The entire submission may also be printed by pressing the Print button. Press the blue Submit to APS button at the top of the screen to submit the review. 13

14 General Instructions - KEPRO CareConnection Prior Authorization (PA) *These instructions provide the general process for submitting a Prior Authorization. For service specific directions please see Appendix C. How to Submit a Prior Authorization (PA) in CareConnection 12. For members With an active MaineCare number: Begin the PA on the New Request page. Enter in the MaineCare number in the Member ID box. Enter in one other piece of identifying information. Click Verify and then click Add Member. 13. For Grant Funded Members or Members Without a MaineCare number: For Grant Funded requests or Non-MaineCare requests, click New Request. Enter a zero (0) for the Member ID and fill in one other piece of identifying information. Click verify then Add Member at the bottom of the screen to start a new review. 14. The Member Information Page - This page will auto-populate for members with a MaineCare number. You are not able to edit this information, as it is a direct feed from MaineCare. Click Save and Continue. 14

15 15. Guardian Information Page - Please complete this page for children and for adults who are under guardianship. Click Save and Continue. 16. Administrative Page a. Choose Prior Authorization for the Authorization Type. b. Enter in the Start date needed for the authorization period. Please note: Prior Authorization Reviews must be submitted within five (5) calendar days of the needed start date. The 5 day window does not apply to Hospitals, PNMI residential or crisis units. Hospitals must submit reviews within 72 hours of starting services, and PNMIs/Crisis Units must submit reviews within 24 hours of starting services. c. Choose Routine in the dropdown menu for This Request is. d. Choose the appropriate Review Type and Category of Service e. Enter in Date of Referral, Location at time of Referral, Date Case Worker Assigned, and Date Seen Face to Face as applicable to the service. Please see Appendix C for service specific instructions. f. Click Save and Continue. 15

16 17. Requesting Agency Page - Fill out all of the sections in red, and click Yes for Is this agency/individual the treating provider? Click Save and Continue. 18. Diagnostic Assessment Page Enter in the Date of Diagnostic Assessment and the Primary Diagnosis. Fill in the remaining fields as appropriate to demonstrate eligibility for the service you are providing. Click Save and Continue. 19. Services Requested Page a. Click on the Add New Procedure Request link. b. Choose the procedure code for the appropriate service. c. Choose the Frequency of Services. d. Choose the NPI number from Provider Billing ID box. 16

17 e. Your service length and units will automatically populate. You may generate the end date automatically by clicking in the Service Length box and hitting the tab key on your keyboard. f. Repeat steps a through e for every service needed g. Click Save and Continue. 20. Symptoms/Behavior Page Complete page as required for your service. Click Save and Continue. 21. Although not required for every service, it is helpful to include some information on the Psychiatric Medications and the Clinical Indicators pages. Click Save and Continue when done with each page to move forward. Psychiatric Medications 17

18 Clinical Indicators 22. RDS Page The RDS page is required for Section 17 and Section 92 services. The purpose of this page is to track unmet resource needs related to the goals identified in the member s ISP. If the member has the service or will have the service within 30 days, do not enter it as an unmet need. a. In the ISP Status box, select whether this is the initial ISP, 90 days review of ISP, annual review of ISP, or if the person has left CCS agency. b. In the needed resources section, check off each resource the member does not currently have or receive that is needed to assist the member in meeting the goals identified in the ISP. Please note: there must be a goal or action steps on the ISP identifying the resource needed. c. Once you have identified a needed resource, click the check box and enter in the date it was identified. d. For additional instructions on the RDS page, please visit: Treatment Plan Page Choose at least one strength or skill from the top box labeled Describe Member s Strengths and Skills. To choose multiple items, hold down the CTRL key on your keyboard and select the appropriate strengths and skills. To add a goal, click on the Add New Goal link at the bottom of the treatment plan page. You must enter at least one long term goal and the target date. To add more than two goals, click the Add New Goal link again. Click Save and Continue when complete. 18

19 24. Additional Reporting Data Page Complete this page as required for your service. Click Save and Continue when complete. 25. Transition Discharge Plan Page Complete this page as required for your service. Click Save and Continue when complete. 19

20 26. Additional Information Page It is recommended that this section be used to provide clinical rationale for the services requested. Information should be relevant for purposes of utilization review, highlighting the ways in which the member continues to meet eligibility requirements for the services requested. Click Save and Continue when complete. 27. Document Upload Page To upload a supporting document to your case, select the document type, click browse and then search your computer for the saved document. Once you have located the document, double click to add it and then click the attach button. Please note: Document upload does not replace the requirement to enter clinical data in to CareConnection. Incomplete reviews may be administratively closed. For more information on Document Upload please visit Appendix A of the Provider Manual. 20

21 28. Submit to KEPRO Page Before submission, you may print the treatment plan by pressing the blue Print Treatment Plan button. The entire submission may also be printed by pressing the Print button. Press the blue Submit to KEPRO button at the top of the screen to submit the review. 21

22 General Instructions - KEPRO CareConnection Continued Stay Review (CSR) *These instructions provide the general process for submitting a Continued Stay Review. For service specific directions please see Appendix C. How to Submit a Continued Stay Review (CSR) in CareConnection 1. If you do not know which APS Case ID you need to extend off of, you ll need to go to Search Responses and enter in your client s MaineCare number. Here you will be able to see all of your client s cases. You will want to extend off of the Case ID with the authorized end date the furthest out (meaning the Case ID with the greatest end date, not necessarily the newest Case ID). Check under the word VIEW to ensure that the case is viable and there are no notes requiring your attention. 2. Go to Search Request on the blue bar and type the APS Case ID in the search box. Click Search. Click on the EXT link. This will create your Continued Stay Review. Please make note of your new case ID. 3. Member Information Page This page will auto-populate for members with a MaineCare number. You are not able to edit this information, as it is a direct feed from MaineCare. Click Save and Continue. 22

23 4. Guardian Information Page - Please complete this page for children and for adults who are under guardianship. Click Save and Continue. 5. Administrative Page Enter in the Start Date for Current Authorization. Please note: Continued Stay Reviews must be submitted within ten (10) calendar days of the needed start date. The 10 day window does not apply to Hospitals, PNMI residential or crisis units. Hospitals must submit reviews within 72 hours of starting services, and PNMIs/Crisis Units must submit reviews within 24 hours of starting services. 6. Requesting Agency Page Please update the requesting staff name to the provider s name if need be, making sure to add a phone number and address. 23

24 7. Diagnostic Assessment Page Enter in the Date of Diagnostic Assessment and the Primary Diagnosis. Fill in the remaining fields as appropriate to demonstrate eligibility for the service you are providing. Click Save and Continue. 8. Services Requested Page a. Click on Modify to request a new start date, end date, and units for each service being extended b. Generate the end date automatically by clicking in the Service Length box and hitting the Tab key on your keyboard. c. You may ask for more units than what automatically populates if you anticipate needing them. d. Click No Action if there is an additional service code present that you do not wish to extend. 24

25 9. Symptoms/Behavior Page Complete page as required for your service. Click Save and Continue. 10. Psychiatric Medications Page All medications, both psychiatric and medical should be entered in using the Add Medication button. Answer the Yes/No questions. Click Save and Continue. 11. Clinical Indicators Page Choose the most current symptoms and behaviors that the member has experienced during the previous authorization as required by service. If you ve selected a current severity, also make sure to select the history of severity. Save and Continue when complete. 25

26 12. Treatment and Service History Page Answer all questions as completely as possible and to the best of your knowledge as required by service. Co-occurring questions refer to mental Health and Substance Abuse. 13. RDS Page The RDS page is required for Section 17 and Section 92 services. The purpose of this page is to track unmet resource needs related to the goals identified in the member s ISP. If the member has the service or will have the service within 30 days, do not enter it as an unmet need. a. In the ISP Status box, select whether this is the initial ISP, 90 days review of ISP, annual review of ISP, or if the person has left CCS agency. b. In the needed resources section, check off each resource the member does not currently have or receive that is needed to assist the member in meeting the goals identified in the ISP. Please note: there must be a goal or action steps on the ISP identifying the resource needed. c. Once you have identified a needed resource, click the check box and enter in the date it was identified. d. If you previously identified a needed resource and the member has been able to access that needed resource, enter in the date that it was satisfied. e. If a previously identified needed resource is no longer needed be sure to check off the no longer needed box. Also be sure to indicate in the treatment plan why this resource is no longer needed. f. For additional instructions on the RDS page, please visit: 26

27 14. Treatment Plan Page Choose at least one strength or skill from the top box labeled Describe Member s Strengths and Skills. To choose multiple items, hold down the CTRL key on your keyboard and select the appropriate strengths and skills. To add a goal, click on the Add New Goal link at the bottom of the treatment plan page. You must enter at least one long term goal and the target date. To add more than two goals, click the Add New Goal link again. Click Save and Continue when complete. 27

28 15. Additional Reporting Data Page Complete this page as required for your service. Click Save and Continue when complete. 16. Transition Discharge Plan Page Complete this page as required for your service. Click Save and Continue when complete. 17. Document Upload Page To upload a supporting document to your case, select the document type, click browse and then search your computer for the saved document. Once you have located the document, double click to add it and then click the attach button. Please note: Document upload does not replace the requirement to enter clinical data in to CareConnection. Incomplete reviews may be administratively closed. For more information on Document Upload please visit Appendix A of the Provider Manual. 28

29 18. Additional Information Page It is recommended that this section be used to provide clinical rationale for the services and units requested. Information should be relevant for purposes of utilization review, highlighting the ways in which the member continues to meet eligibility requirements for the services requested. Click Save and Continue when complete. 19. Submit to KEPRO Page Before submission, you may print the treatment plan by pressing the blue Print Treatment Plan button. The entire submission may also be printed by pressing the Print button. Press the blue Submit to KEPRO button at the top of the screen to submit the review. 29

30 General Instructions - KEPRO CareConnection Discharge Review *These instructions provide the general process for submitting a Discharge Review. For service specific directions please see Appendix C. How to Discharge an APS Case ID in CareConnection 1. It is only necessary to discharge the most current APS case ID per service. If you know the most current case ID, proceed to step 2. If not, look up the member using Search Responses screen to determine the appropriate case ID to discharge. Confirm the service code and dates of service, and check the status of the case in question by clicking on View. Once confirmed, take the case ID to Search Services to process the discharge. 2. Go to Search Services and enter the member s most current APS Case ID and click search. 3. Scroll over to the right side of the screen until you see Actions. 4. If the house has a red plus sign in it, the client hasn t been discharged. If the house is empty with a blue person, the client has been discharged. Click on the appropriate red house to proceed to the discharged screen. 5. Click the services to be discharged box at the top of the screen. Any field that is highlighted red is a required field. Make sure to enter in the discharge date as mm/dd/yyyy. Pick the reason for discharge that most represents your client s situation or choose other and enter in the reason. 30

31 6. Fill out any other applicable information and click the Submit button at the bottom of the page. You will then get a popup that says Your Request has been successfully processed. The discharge is now complete. 31