Provider Update: April 1, 2019
To: All ADvantage Providers
Subject: Ending Already Authorized Services
Ending authorized services for a date in the past is causing authorization errors, billing issues, and critical exceptions for providers. Beginning immediately, to assist in resolving this issue, the ADvantage Service Plan Authorization team (SPA) will no longer end or change the following services for a date in the past when processing a service change request.
- Durable Medical Supplies (DME)
- Home Delivered Meals (HDM)
- Adult Day Health (ADH)
- Assisted Living Re-tiers
- Personal Emergency Response Systems (PERS)
- Respite
- Personal Care Assistance (PCA)
- Advanced Supportive/Restorative Personal Care Assistance (ASR)
The already authorized service will be set to end the Sunday after the date the change request is processed by SPA. The new or changed service will be authorized for the following Monday.
Example:
- Date of SPA review is Wednesday, 3/27/2019
- T1019 change request is received going from 48 units/week to 60 units/week with the new units to begin on 3/1/2019
- The T1019 service line of 48 units/week will be authorized to end on 3/31/2019, the Sunday following the date of authorization
- The T1019 service line of 60 units/week will be authorized to begin on 4/1/2019, the following Monday
New or changed services that require additional information from the CM will no longer be given a short term authorization. The new or changed service will either be Authorized or Not Authorized. If Not Authorized the already authorized service will remain in place until the required information is received and reviewed by SPA. Once the required information is approved, the process outlined in the paragraph above will be followed.
These process changes will prevent Prior Authorization errors that result from billing for dates of service beyond the backdated end date.
All requests to add additional services that do not require ending an already authorized service will be authorized for the date it is processed by SPA.
Please remember that a service has not received authorization until the EDI Status shows as 'Approved' or 'Approved by EVV', if an EVV service, on the Member's Auths tab.
Please send any questions regarding the information above through the Harmony PQ chapter.
Thank you.
