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Provider Update: October 16, 2018

Rate Conversion Follow-up 

Priority: HIGH

Topics Addressed:

  • 1). Requests to Convert Lines of Service Needing Unit Adjustments Post Conversion
  • 2). Requests for Additional Case Management (CM) Units
  • 3). Change in Nursing Facility (NF) Respite Code

MSU-AA anticipates that future conversions completed in the new Waiver Management System, Harmony, will be more efficient. However, due to the retrospective nature of the recent rate conversion, providers may find that units on service lines with an annual allotment may require adjustment. Such conversions require the existing service line with the old reimbursement rate to be ended, and a new service line with the new rate to begin one day later.When one service line is ended and another is created, the system must allot units based on defined parameters.In this situation, the system allotted units on the ending line based on either units billed or 15 units per month, whichever was greater.Due to lags in provider billing, this has resulted in units being distributed across the two service lines inconsistent with actual units used.

How to Submit Requests to ConvertLines of Service Needing Additional Units

Œ MSU-AA will make the necessary adjustments to service lines as requested by providers but requests must be submitted according to the following process:  Each Provider will be allowed to submit one request to make a retrospective change on the annual service lines for all their members, movingunits from the active service line to the line impacted by the conversion that ended on 9/30/2018.Please note:  Multiple requests will not be considered.  This is one submission for all required adjustments. 

Requests to adjust service lines must be submitted using the Excel spreadsheet that was attached to this bulletin.     Complete the spreadsheet as follows:  Example:  MSU-AA needs to know how many units providers expect to see on the line ending 9/30/2018 and the line beginning 10/01/18 after the adjustment is made.  If there are 45 units on the line ending 9/30/18, but the provider needs it to be 55, enter 55 in the spreadsheet under the column heading that states, "Total Number of Units for Line Ending 9/30/18". Providers should then enter the number of units that remain under the column heading that states, "Number of Units Remaining on Line Beginning 10/01/18".  The total remaining units will automatically calculate in the spreadsheet.  MSU-AA staff will only move lines from the begining line (10/01/18) to the line ending (09/30/18).  If the total remaining units exceeds 175, MSU-AA will not adjust the line.

Additional need to know information for making line adjustments: 

The Provider’s billing must be current through 9/30 so as to capture all units used and any additional units needed. 

Requests to add units to a service line beginning 11/1/2018 or after must occur via the process in the next section. 

Requests will be workedin the order in which they were received.  üRequests for unit adjustments are time limited, and will not be accepted after December 31, 2018.

Requests for Additional Case Management (CM) Units

​The ‘Request for Additional Case Management Units’ form resides in Harmony and can be found under the Documents tab within the Member record. In order to process requests for additional CM units, the following must occur: The Request form must be appropriately documented and the status of the form marked as Complete. Additionally, the CM will need to initiate a change in services to a Members current plan.  This process is also to be used if, at the end of the plan year, the Provider wishes to move any unused units from the service line ending 9/30/2018 forward to the line beginning 10/1/2018.Provider billing must be current prior to requesting additional units.

Presumptive requests for additional CM units will not be considered unless a condition exists where the Member’s authorization for CM units is at risk of depletion.  For example, if a Member’s plan is ending and CM units are certain to be depleted


Change in Nursing Facility Respite Code

The code for NF Respite has changed from UB120 to 0120.

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

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