Provider Update: March 19, 2019
To: All ADvantage and State Plan Personal Care Providers
Subject: Weekly Harmony Status Updates
The Medicaid Services Unit will begin sending out weekly updates on the status of key areas of interest to providers working in the Harmony system. Our hope is that this information will:
- Educate providers on the status of requests/service plans submitted to the Medicaid Services Unit (ADvantage and State Plan Personal Care programs)
- Allow providers to communicate with and better serve program Members
- Prevent avoidable service disruptions
- Provide transparency in the assimilation of Harmony as the fully-functioning waiver management information system for both ADvantage and SPPC
We are changing this update to a narrative format for ease in reading. As always, if there are areas that could be included in this report that would support you in your service to our program Members, please let us know.
Service Plan Processing
- Oldest working date for MSU-ADvantage is 2/18/2019
- If there are any plans/plan revisions in a review status prior to this date, please advise via Provider Question (PQ). Include identifying member information and plan number.
- Oldest working date for MSU-SPPC is 3/14/2019
- Work on unit adjustment spreadsheets continues with several of the largest providers either completed or in progress
- We are often finding the adjustments are incorrect and do not correspond with what was actually billed, resulting in PA errors
- We address PA errors daily, however some will require actions by the provider agency. In these cases, the agency will be contacted to inform of what actions are needed.
- Agency-specific case management trainings continue every Tuesday and Thursday
- Response has been very positive
- We recommend that agencies include as many front-line staff as possible as their questions and insights are helpful in educating others and identifying trends
- Lunch and Learn sessions continue every other Wednesday; topics vary based on trends and requests for information. The next Lunch and Learn is scheduled for 03/27/2019.
- We understand that reporting is a high level priority for ADvantage providers and are working diligently with WellSky, the Harmony vendor, to develop reports as quickly as possible.
- The Harmony Census Report is currently near completion and we anticipate it becoming available during the next two weeks
- Because the case closure process is labor-intensive in Harmony, we are currently behind in this process. Notification of case closure is communicated via an Alert until we can get the case closed.
- Effective today, 3/19/2019, we will be taking the following actions in Harmony to cut the closure process in half:
- Previously, in order to fully close a plan, we had been ending every service line in the Planned Services subtab on the effective date of the closure
- We will now only end the authorizations on the effective date of the closure; this will prevent billing on closed lines after the date of the close
- Provider enrollments will also be closed
- We believe this process change will not only shorten the time required to complete a case closure, it will also facilitate a reopen in the event the closure is for a short-term only.
21st Century Cures Act
- ADvantage and SPPC are well situated for implementation of the Cures Act, which is the requirement for states to implement EVV for all in-home services by January 2020
- Consumer direction (CD-PASS) is not a part of EVV at this time, however we are working with the Oklahoma Health Care Authority (OHCA), the state Medicaid agency, to include this service option into EVV
- First Data will continue to provide EVV services for all in-home provider agencies through the Authenticare system
- We understand that critical exceptions are a current problem in the EVV system and are working with program and First Data staff to identify issues, trends, problem-solve, etc.
- As we continue to prepare for the requirements of the Cures Act, we will inform in-home care providers of any relevant process changes