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Provider Update: February 17, 2016

Case Manager Tools for Successful Document Submissions/Cost Saving Measures

Medicaid Services Unit continues to review and consider cost savings proposals submitted by providers, implementing as many as feasibly appropriate. After determining what immediate action could be taken in response to the suggestions, three "Case Manager Checklists" have been created. These checklists will result in more timely processing times for Service Plan authorization.  These tools can be used to guide the Case Manager through the Service Plan submission process for each type of service request.

The MSU encourages all Case Management provider agencies to begin utilizing these tools immediately. These tools are for internal agency use to assist with document submission and are not required to be sent with Service Request documentation.

These tools will soon be accessible in the CM tool box, listed under Service Plan Development, located at:

Responding to several other cost saving measures recommended by our providers, specifically assurance of receipt of the Service Plan Review (SPR/ADv8) the MSU has provided additional clarification information below.

The current Waiver Management Information System only allows an SPR to be sent with the ADv6g sent immediately following processing of a Service Plan Cost Sheet or Addendum that initially triggered the SPR. The System does not send the SPR on subsequent ADv6g's. It is extremely important the Case Manager is aware of this information, as policy states the Case Manager has 14 days to respond to an SPR.

Additionally, we are asking providers to review your agency's processes related to receiving an ADv6g and/or SPR (ADv8) to ensure alignment with MSU's requirements for receiving, maintaining and processing this information, making certain that all documents received are placed in the Member's record. In the event the Case Manager did not receive the SPR and the authorization line on the ADv6g states "See SPR", the Case Manager should request a copy via Provider Question.

If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail at:

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