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Provider Update: April 15, 2019

To: All ADvantage and State Plan Personal Care Providers

Subject:  Weekly Harmony Status Updates

The Medicaid Services Unit is 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

As always, if there are areas that could be included in this report that would support you in your service to our Members, please let us know.

Thank you.

Service Plan Processing
  • Oldest working date for MSU-ADvantage is 3/25/2019
    • 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 4/12/2019
  • Work on unit adjustment spreadsheets has been completed for Case Management
    • There are instances where the units could not be adjusted due to multiple line changes, etc.  These are being worked individually by MSU staff.
  • Backdating existing service lines is an issue that frequently results in Prior Authorization errors
    • A bulletin has gone out to address ending service lines prospectively to avoid creating these errors
  • An issue occurred last week that prevented authorizations from being transmitted to EVV.  Since then, the same issue recurred several times.  Authorizations were manually pushed through to EVV by WellSky (Harmony) staff to allow providers to bill as needed on these authorizations, so impact on providers has been minimal.  The issue was corrected last Thursday, and all processes are running without issue at this time.
  • Standard Naming Convention
    • MSU staff are working on a standardized naming system for documents that are uploaded in the Harmony system.  Standardized naming will allow MSU and provider agency staff to more easily and consistently identify uploaded documents and associate them with specific member plans.  A bulletin will be sent out prior to implementation.
  • The state of Oklahoma must come into compliance with section 12006 of the 21st Century Cures Act by implementing EVV for all home and community-based services (HCBS) waiver members.
  • ADvantage is well set for this implementation as all home care services (except self-direction) are currently required to use EVV for claims development and submission to OHCA.
  • The Oklahoma Health Care Authority (OHCA), our state Medicaid agency, has chosen to have an open model for EVV implementation.  This means that each state agency can use/continue to use the EVV vendor(s) of their choice for their waivers.
    • ADvantage will continue to use First Data (Authenticare) for our non-self-directed members.
    • ADvantage will need to come into compliance by bringing EVV to the CD-PASS (self-directed) population.
      • ADvantage leadership has been working with OHCA, DHS Finance and Contracts personnel to establish the necessary relationships for implementation of EVV for CD-PASS.
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