Batch Technical Assistance (Authorization and Discharge)

Transcription

1 Batch Technical Assistance (Authorization and Discharge)

2 Welcome & Introductions Georgia Collaborative ASO Candy Schaffer, Corp-IT Business Analyst III Casey Spencer, Supervisor EDI Helpdesk Andrew Leece, Provider Relations Communications Specialist Brian Erdoes, Business Systems Analyst, EDI Helpdesk 2

3 Questions from Registration 3

4 Authorization Q) How can we submit authorizations and how long are the authorizations good for? A) Authorization requests can be submitted via batch or through ProviderConnect for most services. Authorizations can vary in length depending on the specific service being requested. Note: Some services cannot be submitted through batch, such as: Inpatient PRTF Initial CBAY CSU Housing Voucher 4

5 Authorization Q) How many batch authorization files can we send out daily and what is the turn around time to receive authorizations approval? A) We will not limit the amount of files sent per day. The batches will be processed twice a day, response time will be determined by volume of submissions. Q) Is cumulative scoring required to be sent for CANS and ANSA? A) No, it is not required. 5

6 Authorization Q) Is medication documentation optional, and should we just ask for the maximum units for authorization requests? A) Medication documentation is optional, but is often helpful when review requests that require a medical necessity review. Provider should submit authorizations requesting the number of units that are medically necessary for providing the service, with consideration to the plan of care the provider developed with the individual. 6

7 Authorization Q) Is there an authorization error when a registration hasn t been processed or is currently not in effect? A) Yes, the authorization will error if a registration is not in place. Furthermore, if the individual is not eligible for any funds, then the authorization request will not be able to be submitted. The individual needs to be eligible on the requested start date for an authorization request. 7

8 Authorization and Discharge Q) Can you submit authorization and discharges in one file? A) No, these are separate files that have separate directories to which they must be sent. Q) What type of file will be used? A) The batch should be created as a text file. 8

9 Discharge Q) Why would a client be discharged? A) An individual would be discharged upon completion of treatment or services. Q) Will automatic discharges be done when an individual has not received services for 90 days? A) Yes, there is an administrative discharge process developed. Providers should submit discharge reviews when discharging individuals from their services, though. 9

10 Discharge Q) When an individual is discharged and they come back into service, do we need to register them again? A) If the individual has a registration on file that includes the funds that cover the authorization request then a new registration would not need to be completed. You would need to submit a new authorization request, however. 10

11 Discharge Q) Since services are no longer packaged, will we have to discharge an individual from each service enrolled? Multiple Outpatient services Services can be discontinued without a formal discharge Outpatient and HLOC Discharge should be submitted upon completion of that service type 11

12 Process Q) How will the retro Medicaid process work? Medicaid eligibility previously authorized? NO Submit a registration and authorization request YES The Georgia Collaborative ASO will run reports to pass these authorizations 12

13 Process Q) If a therapy service is normally one hour with a 15 minute unit, should the request be for one or four units per visit? A) If the service is a 15 minute unit, then four units should be requested for one hour of service. Q) When will the file layout be available, and how can they be submitted electronically? A) The companion guides are available on our website, and we will demonstrate the batch submission process. Basic PowerPoint Template 13

14 Batch Authorization and Discharge Steps 14

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19 Batch Authorization and Discharge Steps 19

20 Thank you For Georgia Collaborative ASO general inquiry or questions please 20