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Provider Update: December 26, 2018

Service Plan Authorization Issue

Medicaid Services Unit – ADvantage Administration would like to thank our provider network for providing reports and information on Members having outlying service plans without authorization.  Because of these reports, we asked our Harmony vendor to provide us with a list of every service plan in any type of review status beginning on the go-live date of 8/27/2018.  We discovered a large number of plans in varying stages of completion, some dating back to the beginning of October 2018.

We are working through this list from oldest to newest as quickly as possible.  Some of the Members on the list actually do have plans/services fully authorized; the status was just not updated to show an open plan.  Some have individual service lines that were not authorized, and, in a few cases, we have found entire service plans without authorization.  We have assigned this list out to multiple members of our staff in order to get these reviews accomplished quickly.

ADvantage staff and DHS leadership met with the leadership of the Harmony vendor, WellSky, to share our concerns on finding Members without service authorizations about which we were unaware.  In addition, we have emphasized our needs in other areas, such as reports and service tracking.  Going forward, we will be meeting with the vendor routinely to address issues and progress toward goals.

Thank you for your patience and advocacy as we work together to provide services to our ADvantage Members.

 Please send any questions regarding the information above through the Harmony PQ chapter.

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