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Provider Update: January 29, 2016

Process Enhancements for Service Authorization Processing Times

The Medicaid Services Unit recently implemented a pilot project with a targeted outcome of improving processing times for service plan authorizations. This project was focused on "receivables", which includes mail, fax and hand delivered documents submitted for service authorization.  

We are providing the results of the project because the data suggests opportunities for potential improvements.  If proposed changes are made in the way MSU receives documentation from providers, providers may realize benefits in terms of cost savings, as well as faster response times for service authorizations. 

MSU designated the month of January to this effort. Staff committed to the "Receivables Project", reviewed and documented whether or not mail and faxes received were "complete or incomplete" upon receipt.  To be considered complete, the packet delivered had to identify, (according to ADv6f, or other cover page), how many actual documents were included.  If the staff could verify that all documents were enclosed, it would be marked as complete. 

The majority of correspondence the MSU receives is mail via envelopes containing packets. An envelope may contain up to 50 or more individual packets, and MSU staff touches each of these documents. MSU processes in excess of 2,139,574 individual pages per year.  During the pilot, the volume of mail received was consistent with what was expected, although the number of faxes received appears to have increased, partly due to non-priority requests being included in the overall number received. Generally, MSU only accepts priority requests identified by the Case Manager, within the parameters identified as an urgent request via fax.

Results of the January, 2016 pilot:

Number and Type of Correspondence Received Overall Percentage of Incomplete Documents
Mail via Postal Service 3468 Packets (not single pages ) 16% (627)
Faxes 1214 Packets (not single pages ) 52% (544)

What can be done to implement improvements?:

If the number of incomplete packets is reduced, it will positively affect processing times as there will be less likelihood that processing a plan will be delayed.  This will also lower provider costs in postage, and it will reduce the effort expended by provider staff responsible for submitting mail and fax.  In addition, this will decrease the time spent by the Case Manager correcting conditions relating to missing information.

There are, however, other issues that delay service plan authorization. Providers are encouraged to review with agency staff best practices for ensuring no documentation is omitted prior to submission, documents are legible, all required signatures are present, and packages are complete.  Please also provide staff with the below list of other common issues that delay service plan processing.

Common Missing Information:  Missing Pages
  • UCAT III (random pages often missing)
  • Scoring Matrix
  • Page(s) of RN evaluation
  • Request for DME supplies and equipment- Grab Bars/PERS
  • Hospice Plan of Care
  • Service Authorization Packet Checklist (ADv6F)
Missing Signatures
  • Case Manager signature, written, not typed, on UCAT III
  • Service Plan Cost Sheet - Case Manager/Case Manager Supervisor/Member
  • Service Plan Cost Sheet Addendum - Case Manager/Case Manager Supervisor/Member
Missing Information
  • Justification for services requested on the Service Plan Cost Sheet
  • Justification for services requested on the Service Plan Cost Sheet Addendum
  • Justification of need - DME
  • Incomplete Summary on UCAT III Page - 11 (approximately)
  • Missing goal for request – Example: DME to install and instruct on Grab bars
  • Not addressing the Medicare Home Health Aide in goals
  • Health and Safety Indicators often overlooked and not addressed on the Goals
Missing Documents
  • RN evaluation
  • Physicians prescription for Nutritional Supplement / Must include route of administration
  • Hospice Plan of Care
  • Additional Bid(s) for DME when cost are not usual and customary for the request and/or no justification addressing reason for no additional bids
Additional findings observed - Inconsistent information throughout UCAT, between UCAT and RN Evaluation, between UCAT and Service Plan/Goals, between Service Plan and Goals, etc.

Please also see the attachments that were added as assistance for ensuring service plan authorizations are processed timely including:

  1. A list of measures implemented by MSU to have more timely authorizations
  2. A reference guide for Case Manager responsibilities        

  3. We have also made available additional hand-outs that were shared with providers who attended the Quarterly Meeting on January 25, 2016, which included:

     
  1. Skilled Nursing Code Change Information
  2. Health and Safety Indicators
  3. MSU Measures Implemented for Timely Authorizations
  4. ADvantage Case Manager Timeline(s) Quick Reference Guide

Additionally, we have attached information received from Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) that lists behavioral health resources by city, which was information requested during the Quarterly Meeting. http://ok.gov/odmhsas/Mental_Health_/Oklahoma_Health_Homes_Learning_Collaborative/

If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail at:  aauproviderquestion@aau.okdhs.org

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