Provider Update - October 1, 2018
The following bullets are the most commonly occurring CM errors our Service Plan Authorization unit is observing in the Harmony system. These errors are slowing down processing time and Member services. It is critical that CM's review and take action on the following information when entering plans into Harmony.
- When there is a change in services (addendum) to the existing service plan, the CM should ensure the change (adding service(s) and/or ending service(s)) is within the existing plan year (usually has a future end date). Adding an entirely new plan is not part of this process; please refer to job sheet entitled: ADv.SPPC_CM.HCAgency_Change in Service (Former Addendum), for additional information.
- Once a service is authorized on a plan, the CM should not make changes to the service code, provider, amount of units, etc. Instead, the only changes that should ever be made to plans or planned services that came over on the conversion would be if they are a transfer, a service increase, service decrease or request to end service. In those cases, only, the End Date would require revision. Excluding requests for additional CM units and new plans.
For example, if the Member needs an increase in services, the CM needs to End date the appropriate service and then Add the same service that is replacing the one that is ending with a new begin date and new amount of units; similar to the process Providers followed prior to Harmony on paper addendums.
- When entering a New Plan, the CM needs to add service(s) and/or end service(s) in the existing plan year (Plan 1, which doesn't end until 2019 in most cases) and extend the End Date to end of plan year, amount of units and frequency for T1016 and T1002 that were entered by MSU. Adding an entirely new plan is not part of this process.
- When adding a reassessment it is not appropriate to combine next years' planned services into the current years' service plan, as this is not part of the process. The dates of the plan that came over on the conversion should never be changed. A new plan with new service plan dates should be established for the reassessment plan, and all new services entered into that plan.
CM Supervisor Review
- Evidence of the CM Supervisor review must be present in order for review and authorization to occur. This is completed by the CM by adding a plan note for the Supervisor to review. Please refer to job sheet entitled: ADV_CMAgency_CM Initial IDT, steps 165-167, for additional information.
- Corresponding documents (i.e. Nurse Evaluation, Service Team Release, UCAT, etc.) located in the Documents tab, must have a status of Complete, in order for MSU staff to review and/or authorize accordingly.
- All Priorities should be requested by adding a Plan Note stating the justification of priority processing. Lack of a note will be automatic denial of priority processing (except UB120, AL or CD-PASS).
- UB120 requests must be certain the Number of Units = "1" and the Frequency = Calendar Day.
If you have any questions regarding the information provided above, please feel free to contact us via SmarterMail at: