Provider Update: January 14, 2019

To: All ADvantage Case Management and Home Care Providers

Subject: (1) Change in Submission Process for all Responses to Clinical Conditions and
                (2) Review Status Clarification

In an effort to improve service plan authorization turnaround times, we are making a routing change in the Case Management Supervisor submission process for all Clinical Review and CD-PASS conditions.

Going forward, Clinical and CD-PASS staff will advise in the Plan Note containing the condition if the Case Manager should route the response to a specific review team.If there is no direction to route to a specific review team, the status should be set for SPA Review per the normal process.

Effective immediately, the Case Manager Supervisor should submit responses to conditions placed by either the Clinical Review or CD-PASS team according to the following process:

1.    Complete all supervisory service plan review activities according to Job Sheet instructions.

2.    Complete service plan validation to ensure any outstanding issues have been corrected / addressed by the Case Manager.

3.    PROCESS CHANGE:

1. When changing the Plan Status for submission of the service correction to the MSU-AA, select "Clinical Review" from the drop-down list, regardless of the direction given by plan validation.
2. When changing the Plan Status for submission of the CD-PASS service correction to the MSU-AA, select "CD-PASS Review" from the drop-down list, regardless of the direction given by plan validation.

This process change will support faster service authorization.  Routing of service plans to the various review teams will be completed internally by MSU-AA staff.

>>>IMPORTANT NOTE<<<

• This change affects all Clinical and CD-PASS condition correction submissions going forward.Please DO NOT CHANGE the status of any previous submissions as this will further slowdown the review process.

Additional Plan and Review Statuses have been added to the Harmony system.  The statuses will allow for both MSU staff and Case Managers to have a better understanding of where the review is at, as well as clarify what service lines have ended or have short authorizations – please see screen shots below.

Please note:  If you have any questions regarding the information provided above, please send questions through the PQ chapter in Harmony.