Medicaid Service Update: July 28, 2021

To:  ADvantage Case Managers

Subject: ADvantage Not Authorized or Short Authorization Notification Process

Date:  July 28, 2021

Effective 7/29/2021 MSU AA will no longer send Plan Notes to the CM/CMS containing reason(s) for not authorizing or providing a short authorization on service plan lines. A new process has been implemented as follows:

• A new plan status of “CM Action Required” has been added to Harmony. MSU AA will use this status to flag the plan for the CM so they are aware there is either a “Not Authorized Service” or a “Short Authorization” that requires additional action to obtain the full authorization.
• CM’s should monitor their My Harmony Chapter/Members Column/Plans area daily to look for any plans in a status of “CM Action Required”. 

• If any plans are identified as having the status of “CM Action Required” the CM should proceed as follows:
  • Navigate to the Plans Tab of the Member record
  • Open the specific plan with this status
  • Open the Planned Services sub-tab
  • Review the “Service Line Status” column for the specific service that is either “Not Authorized” or has a “Short Authorization”

• The CM should open the planned service and view the not authorized reason(s) and/or any lines listed as short authorization and proceed as follows:
  • Make correction to the Member record, as appropriate
  • Submit the plan to the CMS by using a Plan Status of “Supervisor Review”
  • The CMS should review the updates and submit the plan to MSU as appropriate. *When responding to conditions or short authorizations, CM should add a Plan Note identifying the condition in which they are responding by using the Note Type = Service Plan and Not Sub-Type = Response to Condition.

*CM may be directed to read conditions added to the Comments area on the service plan line if a suitable dropdown is not available.  A Plan Note may still be used by exception.

• CM Agencies may also monitor “Not Authorized” planned services by running the “Not Authorized Services” report on the Reports Chapter. *Short Authorizations do not show on this report.

• Plan Status Definitions are found in the library site.
  https://drive.google.com/drive/folders/1VWD4Hz2T71w9_BKtjzwn83r4KJSu6t9X

If you have any questions regarding the information provided above, please feel free to contact us via Harmony Provider Question.     

COMMUNITY LIVING, AGING AND PROTECTIVE SERVICES | MEDICAID SERVICES UNIT
ADvantage Administration | State Plan Care Unit | Medical Eligibility Services
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