Provider Update: July 1, 2019
To: All ADvantage and State Plan Personal Care Providers
Subject: Harmony Status Updates
The Medicaid Services Unit is sending out periodic updates on the status of key areas of interest to providers working in the Harmony system. If there are areas that you wish to see included in this report, please let us know.
Service Plan Processing
- Oldest working date for plans in SPA Review status is 6/18/2019
- Please be sure to submit all plans/plan changes to SPA Review status unless directed to do otherwise in a Note from MSU staff.
- Oldest working date for plans in Clinical Review status is 6/13/2019
- If there are any plans/plan changes in one of the above review status prior to the date for that review type, please advise via Provider Question (PQ). Include identifying member information and plan number.
- Please visit the Harmony Project webpage at http://www.okdhs.org/services/aging/Pages/HarmonyProject.aspx.
- Please see the Harmony System Update (located under the header 'Harmony Training').
- NOTE:NEW INFORMATION HAS BEEN ADDED
- Reminder: The Harmony system is an electronic health record, and as such should only include professional documentation.
- Below is a summary of all authorizations in the Harmony system to date. Definitions begin below the table.
|EDI Status Summary |
|Auth Service EDI Status||Total Authorizations||Percent of Total Authorizations|
|Approved by EVV||192,811||57.79%|
|Ready for EVV||649||0.19%|
|Ready to Send||1,736||0.52%|
|Unable to Send||2||0.00%|
EDI Status Definitions:
- Approved – Auth Service is a Non-EVV service and has been approved by MSU and OHCA
- Approved by EVV – Auth service is an EVV service (goes to First Data (FD)) and has been approved by MSU, OHCA and FD
- Never Send – We have some SPPC auths in this status that were created during our end of year clean up and have not gone to FD and do not need to go to FD. We will be deleting and cleaning up as time allows
- NEW – These are Auths from our last rate change where the units for the auth had been used on the 9/30 ending line and the new line had 0 units on it. They have not gone to OHCA or EVV and are being reviewed and either deleted or sent on to OHCA or EVV as appropriate.
- Pended and Pending – These are used for auths that have been unlocked from a Sent status so they can be reviewed and corrected.
- Ready for EVV – This is the status once an auth is approved by MSU and OHCA and ready to go to the EVV system.
- Ready to Send – These are auths that are ready to be sent to OHCA for processing. Some of these are SPPC auths that do not start until 1/1/2020 and will remain in this status until Dec when the new PA is received.
- Rejected – This is the status when the Auth has a PA error. The informatics unit is working to clean these up as quickly as possible. About a month ago we had around 14,000+ in this status. Much of this is due to back dating that was happening early on in the system.
- Sent – This is the status when the auth is sent to OHCA for processing. This specific auth listed has some issues and I have a support ticket submitted to WellSky to resolve.
- Terminated – Early on we were using Terminated as the EDI status on some terminated auths. That is no longer being used so this number should not grow. Terminated auths will go to Approved or Approved by EVV once processed.
- Unable to Send – There are issues with these 2 auths and I have a WellSky support ticket submitted to resolve.
- 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 will 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