Provider Update: March 18, 2016
NEW, MANDATORY ADv2, ADv9, and ADv15, Priority Requests Procedures via SmarterMail
(Attachments- Four (4) Examples/Templates)
The MSU is implementing many changes due to the current State Budgetary constraints. These changes include a reduction in staff throughout MSU, including the ADvantage Administration office in Tulsa. To combat these challenges we have and will continue to modify several of our manual processes. We have determined the most efficient way to submit the forms listed within this communication to be via SmarterMail. At this time, we are asking for our provider's collaboration in streamlining these processes.
In keeping with our commitment to transparency, we are advising our providers to anticipate substantial delays in processing authorizations. To alleviate additional delays we have provided guidance regarding specific timelines to submit requests, in addition to tools to assist our case managers to be in compliance with policy and current processes.
CHANGE #1. Effective immediately, the following forms will onlybe accepted via SmarterMail (aauproviderquestion@aau.okdhs.org) or Via Provider Question E-Fax (1-405-230-8017):
- ADv2-Voluntary Withdrawal Request
- ADv15-Discharge Evaluation
- Types of ADv9 Provider Communication forms:
- ICD-10 updates
- Member Address and Phone Number Changes (Demographic Changes)
- In-house Case Manager Changes
- Suspend/Resume Status Changes
- All communication(s) not specific to Member Service Requests for Service Plan Authorization (Examples of communications not specific to Member Service Requests for Service Plan Authorization include, but not limited to, - Information on staffing challenges with the Home Care Agency, and Member compliance issues)
Note regarding the ADv9's specifically related to the Members New Plan, Reassessment/Reactivation, or response to conditions and/or SPR's- these communications will continue to be sent in the packet submission via mail and or hand delivery. (Example of a communication specific to Member Service Requests for Service Plan Authorization – a justification for a service request. Justifications of a service request are to be submitted with the services packet request via mail (USPS) or hand delivery).
MSU allows a transition period of 10 business days, for all providers to come into compliance with this requirement. Documents received outside of required delivery method may not be processed on or after April 4, 2016.
Email subject line naming convention rules for this process:
The subject line for these request(s) will indicate the Members initials, the nine digit DHS ID, along with the type of request as these examples below:
EXAMPLES
ADv9's submission will follow the same naming convention that should include the reason for the Provider Communication as follows:
DJ 123456789 ADv 9 Resume
DJ 123456789 ADv 9 Suspend
DJ 123456789 ADv 9 ICD10 update
DJ 123456789 ADv 9 Demo (For Demographic Changes)
DJ 123456789 ADv 9 CM IHT (For Case Manager in House Transfer)
CHANGE #2. Please begin this process starting today (mandatory on 04/04/2016), we are requesting all priority requests be sent via SmarterMail to the following SmarterMail address:
Removal of the SPA fax line (1-405-230-8019) will occur on April 4, 2016.
The Service Plan Authorization priority fax number currently used to submit priority reviews (1-405-230-8019) will be discontinued on April 4, 2016. Priority faxes to SPA fax line (1-405-230-8019) will no longer be received on or after April 4, 2016.
Priority requests are services that need to be authorized immediately to protect a Member's health and welfare. Please do not identify documents as 'Priority' if they do not meet this criterion.
If the request does not meet this criterion, the request will be returned to the provider for the Case Manager to submit via the standard mail or hand delivery process.
Examples of priority requests:
- T1999/B5140- Nutritional Supplement requests
- UB120-Nursing Facility Respite
- G0299-G0300(TF) – Nursing Visits/medication oversight, wound management
- T1019-T1019 (TF) Personal Care increased needs of member due to recent illness, hospitalization or loss/ change of member's informal support.
MSU, in reviewing provider's data from pilot project, has made the determination that this mandatory process is an effective time and cost savings measure for both provider agencies and MSU. In the coming weeks/months, we will introduce more time and cost savings solutions to help combat current business environment challenges.
Again all priority requests must be submitted through SmarterMail at msu.prioritydocuments@aau.okdhs.org
Notice:
MSU staff will no longer contact your agency to request missing Case Manager and Case Management Supervisor signatures on Service Plan Cost Sheets and Service Plan Cost Sheet Addendums. - Please ensure these signatures are present prior to submitting. The Service Plan Authorization unit will place the appropriate condition on the 6g regarding the missing information.
Failure to submit the appropriate signatures will cause delays in critical Member Service delivery, may cause your agency to be out of compliance in audit reviews, and may also cause significant billing concerns for your agency.
Additional Mandatory Request to expedite review and authorizations:
For all mail and hand delivery packet submissions- Please sort and insert a separation page to identify document types such as New Plan, Reassessment, Reactivation, Addendum, Response(s) to Condition(s), etc. (Please see attached examples for use at your agency.)
Each Member service request packet should have either an ADv6f (Service Authorization Packet Checklist) or an ADv6g proceeding the rest of the documentation. The separation page should be directly in front of the ADv6f or ADv6g between each Member service request submission (If a packet contains, 11 service requests – 2 New Plans, 3 Reassessments, 1 Addendum, and 5 Responses to Conditions, there should be a total of 11 separation pages, submitted between each Member submission).
Reminders to prevent service and billing delays.
Please check all documents for accuracy, legibility, and signatures/dates.
Please do not submit a fax or email to an MSU staff fax or email address unless specifically requested by the MSU staff who owns that email or fax account, as these will not be processed unless requested by the staff.
Please refrain from submitting duplicate requests.
Please check the EVV portal for updates regarding the current processing dates in Service Plan Authorization, the portal is updated every Monday AM.
*For your convenience, digitized ADv2, ADv9, and ADv15 forms may be found at:
If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail at: aauproviderquestion@aau.okdhs.org
