PCA Steps for Success - Day 3

Transcription

MHCP Provider Education Personal Care Provider Agencies
PCA Services
“Steps for Success” Workshop
Minnesota Health Care Programs (MHCP)
Individual PCA Enrollment
PCA Steps for Success - Day 3 - May 2012
1
Verify the PCA is not on the OIG exclusion prior to employment and at least monthly afterwards
Submit background study through NETstudy
Submit enrollment request AFTER receiving notice the background study is complete and the individual PCA is  Not disqualified
 Not disqualified with a set aside
Fax “complete” request to MHCP  Completed MHCP Individual PCA Enrollment Application (DHS‐4469)
 Signed Individual PCA Provider Agreement (DHS‐4611)
PCA Home Page
Enrollment Information
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Forms for Enrolling Individual PCAs
3
Office of Inspector General (OIG) Exclusion List
HHA Office of Inspector General
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Search for Individual PCA
Search Results
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Individual PCA Provider Enrollment Application
Individual PCA Enrollment Application (DHS‐4469)
6
Provider Agreement Individual Personal Care Assistant (PCA)
(DHS‐4611)
Request for Resubmission
(DHS‐5678)
7
Helpful Hints Letter
Individual Change Form
(DHS‐5716)
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Individual PCA Information Change Form (DHS‐5716)
MN–ITS Interactive
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MN–ITS Interactive Web Based Provider Tool
Accessing MN‐ITS Mailbox
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Provider Enrollment Correspondence
Eligibility Verification
Service Authorization Letters
Remittance Advice
Questions
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MN–ITS Interactive Eligibility Request (270/271)
Provider responsibility
Verify prior to providing services
Displays coverage “known”
Displays eligibility information based on the “From Date” requested
Results are viewable, savable & printable
MN‐ITS Interactive
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MN‐ITS Home Page Login Menu and What’s New
MN‐ITS Administrator & User Guides
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MN‐ITS Login
Mailbox Home
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Miscellaneous Received
Miscellaneous Received Service Authorization Letters (SAL)
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SAL Files
User Guides
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MN‐ITS User Guides
MN‐ITS User Administration
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Access and Use MN‐ITS Mailbox
Provider Lists
Individual PCAs
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MHCP PCA Provider List
Provider Lists
(Individual PCAs)
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Logout
• MN‐ITS
• ELIGIBILITY
• REQUEST
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Verify Eligibility (270/271) User Guide
Using MN–ITS Interactive
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MN‐ITS Login
MN‐ITS Interactive
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Eligibility Request (270)
MN–ITS Eligibility Request
Single Eligibility Inquiry
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Multiple Eligibility Inquiry
Eligibility Help Pop‐up
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Subscriber ID & Birth date
Name and Birth Date
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SSN and Name
ID, Birth Date and Last Name
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Multiple Entries
Multiple Entries Last Line Deleted
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Eligibility Response (271)
Eligibility Response
Major Programs
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Major Programs
Pop up
Prepaid & Restricted Subscriber
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Fee‐for‐Service Recipient
Other Insurance/Medicare information
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Benefit Limits
Subscriber Not Found
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Invalid/Missing Date of Birth
Eligibility Inquiry
Return to Main Menu
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Logout of MN‐ITS
Questions
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Service Authorization
• DSD PCA Reference Guide
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45 Temporary Increase of PCA Services
45‐Day Temporary Start of PCA Services Discontinue as Provider of PCA Services
Temporary Health Plan (PMAP) Disenrollment
Transition between Fee‐for‐Service PCA & Waiver
• SA Quick Reference Guide
– Change in Responsible Party
– Change in Recipient PMI
– Additional Changes
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45‐Day Temporary Increase of PCA Services
45‐Day Temporary Start of PCA Service
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Discontinue as Provider of PCA Services
Temporary Health Plan (PMAP) Disenrollment Process
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Transition between Fee‐for‐Service PCA and Waiver
Service Agreement Quick Reference Guide (SA QRG)
SA QRG
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MA Home Care Fax Form (DHS‐4074)
Questions
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Reassessment
Change in Condition/Reassessment
• Use Referral for PCA Services Form (DHS‐
3244P)
• Fax request to PHN/CM 60 days prior to end of current SA
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Referral for PCA Services (DHS‐3244)
Questions
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PCA Agency Documentation
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Provider Requirements
Home Care Bill of Rights
Recipient Assessment & Service Plan
Recipient Care Plan Documentation of Medical necessity
PCA Provider Agency
Documentation Requirements
MHCP Provider Manual Provider Requirements (Chapter 1) PCA (Chapter 24)
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PCA Provider Agency
MHCP Provider Requirements
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Health service records
Financial records Access to records Retention of records Copying of records Employee records
Minnesota business requirements
MHCP Provider Manual PCA
Documentation Requirements •
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Home Care Bill of Rights
Documentation of Medical Necessity for PCA Services
PCA Care Plan * QP Supervision notes Assessment and Service Plan
PCA Time and Activity Documentation (DHS‐4691) Referral for PCA Services (DHS‐3244P) when applicable
Indicate on referral if recipient is PCA Choice
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Questions
MHCP Provider Call Center
(651) 431‐2700 or 1‐800‐366‐5411
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Option 1 - Provider Help Desk
Option 5 - Provider Enrollment
Option 6 - MN–ITS Administrators only
Option 7 - Telephone EVS
Option 9 - MHCP & General Information
Remember to check your provider home page
for updated MHCP coverage policy
& billing procedures.
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Thank you for attending!
Minnesota Health Care Programs (MHCP)
Minnesota Department of Human Services
Provider Relations – 2012 PCA Steps for Success - Day 3 - May 2012
43

PCA Steps for Success - Day 3

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