MEDICAID SERVICES UPDATE: August 8, 2014

Transcription

1 OKLAHOMA DEPARTMENT OF HUMAN SERVICES Aging Services, Medicaid Services Unit ADvantage Administratin PO Bx Tulsa, Oklahma (918) MEDICAID SERVICES UPDATE: August 8, 2014 T: Subject: All ADvantage Case Management and Hme Care Prviders Transitin t New IVRA/EVV Sftware System, Sandata IMPORTANT EVV TRANSITION BULLETIN #7 Beginning September 1, 2014, DHS will require agencies t utilize the Sandata EVV system fr the services prvided t members. Services requiring the use f the EVV system: Persnal Care Case Management, Transitin Services Case Management Nursing Advanced Supprtive/ Restrative Assistance In-Hme Respite Persnal Services Assistant Advanced Persnal Services Assistant The purpse f this bulletin is t update Prviders abut the impending changes with the new EVV implementatin. There are suggested steps thrughut this dcument that are included t assist the Prvider t begin internal staff training pre-implementatin. 1. The prcess fr maintaining Diagnsis Cdes in the new Sandata EVV system will be as fllws, beginning September 1, 2014: Pre-implementatin, the Diagnsis Cde will be imprted int each Prviders database as an element f the Member prfile. If fr any reasn the Member Diagnsis Cde changes after the initial imprt the Prvider shuld enter the update. Pst-implementatin any necessary updates f the Member Diagnsis Cde will be changed/entered by the Prvider. When an individual has been determined eligible t receive ADvantage, r SPPC August 8, 2014 MSU Update: IVR/EVV Transitin #7 Page 1

2 services, the Prvider will enter the Diagnsis Cde fr that Member int the EVV system. This field will appear t be blank fr New Members pst-implementatin. At that time the diagnsis cde must be filled in, by the prvider, with the diagnsis cde listed n the ADv6g fr Advantage Members and n the 6g fr SPPC Members. 2. The prcess fr Calling In and Calling Out will primarily remain the same: Previusly referred t as check-in and check-ut n the IVR will nw be referred t as Calling In and Calling Out. Pre-Implementatin Staff Training: Prviders can advise staff that the prcess fr calling in and ut t cmplete the service encunter will remain the same. What will change is the tll-free number that is used currently. Each prvider grup will receive their wn tll-free phne number. There are ther visit types that will be discussed in detail during the upcming training, but basically the fllwing prcedure shuld be fllwed: Calling in: Staff/caregiver visiting the hme will have an ID number assigned t them that is generated by the EVV system, just as they have always used when visiting a hme and using the current EVV. The staff/caregiver will dial a tll-free number and there will be a respnse vice message that will prmpt the Prvider t enter in their ID#. Slwly and clearly the Prvider shuld speak their cde number int the phne receiver. The Call prcess ends, when the prvider hears the system annunce, Received at (time). Calling ut: Staff/caregiver will dial a tll-free number and there will be a respnse vice message that will prmpt the staff/caregiver t enter in their ID#. Slwly and clearly the staff/caregiver shuld speak their cde number int the phne receiver. Press 2 t indicate a Call Out (System prmpt wuld state received at (Time). Enter number f tasks - Wrker wuld enter the key crrespnding fr # f tasks - Prmpts wuld request t enter first Task ID (usually a chart f tasks, and crrespnding numeric cdes, wuld appear n the back f the Call Reference Guide) - If nly ne task perfrmed, system wuld state Yu entered ne task Thank yu, bye., therwise it wuld prmpt fr the next Task ID. The Call prcess ends, when the prvider hears the system annunce, Received at (time). August 8, 2014 MSU Update: IVR/EVV Transitin #7 Page 2

3 3. The claim editing and data entry encunter will change: Prviders are urged t begin training staff respnsible fr editing and entering claims data preimplementatin. The data entry/editing feature f the Santrax system will require staff t change r edit Member schedules rather than the current interface which requires staff t edit Member claims. Prvider staff shuld be prepared t update r crrect the Member schedule t reflect accurate billing fr the service encunter. Sandata will thrughly train this new cncept fr staff attending the upcming training. This infrmatin is being prvided t ffer the Prvider an pprtunity t evaluate current internal prcesses in light f the new implementatin 4. Preparing Schedules t be entered int the EVV system: The preliminary results frm the Prvider Survey demnstrate nt all Prviders use scheduling sftware. Prir t implementatin, all prviders are encuraged t generate a schedule frm the scheduling sftware in use r create staff schedules fr the mnth f September t be used as a schedule template t be entered int the EVV. Having a prepared schedule will help expedite the prcess f data entry and allw Prviders t priritize data input. Fr example schedules may be entered first fr staff wrking 9/1, schedules fr staff wrking n 9/2 wuld be entered next, etc. General registratin fr the EVV is nging. G t the Getting Started with EVV sectin n the newly created EVV web-page at: August 8, 2014 MSU Update: IVR/EVV Transitin #7 Page 3

4 Under Step 3. Register fr EVV Training, identify a date that yu wish t schedule staff and click the hyperlink, which will pen the registratin page fr that date. [Nte: Yu may schedule up t 2 staff ttal frm yur agency fr classrm training. If 2 staff are t be trained, they may register fr the same r fr different dates.] When the registratin page pens cmplete the required fields and submit. August 8, 2014 MSU Update: IVR/EVV Transitin #7 Page 4

5 The Train the Trainer mdel will again be used fr the deplyment f the new IVRA/EVV system. N mre than tw key staff frm each prvider agency will receive in-persn, classrm training n hw t use the system. It is expected that these staff will return t the agency and prvide necessary guidance and training t all f their assciates. We suggest the staff attending the scheduled training include the individual respnsible fr agency billing as well as the individual wh will be assigned as the System Administratr. The System Administratr in this case, wuld be the staff respnsible fr assigning user rles r the ne wh will decide what level f access the agency user will be granted. Please be advised that the limit f 2 attendees per agency will be strictly adhered t, as the capacity f cmputer training sites available have specific ccupancy limits. Seats are limited and registratin will be clsely mnitred t ensure n mre staff register than have been designated. Prviders will have access t an EVV web-page thrughut the implementatin phase and pst implementatin. The page will cntinue t serve as an infrmatin reference pint well int the maintenance the phase. CLAIMS PENDING CLAIMS: AA is mnitring the vlume f pending claims. Please cntinue t recncile all pending claims and submit fr prcessing. It wuld be mst advantageus fr Prviders t recncile, t the degree pssible, all pending claims prir t the September 1 cutver date. Sandata will need Prvider specific infrmatin in rder t begin t set up a data base fr each prvider. Sandata has set up an n-line survey tl s prviders can cnveniently submit the required data. The survey shuld take n mre than 10 minutes. It is crucial that this survey be cmpleted several weeks prir t the g live date f September 1, Yu can lcate this survey n the EVV web-page (same as the training). Please fllw the link belw and cmplete this survey. The survey is nw live and able t start cllecting respnses. August 8, 2014 MSU Update: IVR/EVV Transitin #7 Page 5

6 A LETTER FROM SANDATA T: Advantage Cntracted Case Management and Hme Care Prviders As previusly annunced in Prvider Bulletin #5, DHS is changing IVR/EVV prviders and yur agency will cntinue t be required t participate in the Electrnic Visit Verificatin (EVV) prgram. EVV is defined as a telephne and cmputer based system that electrnically verifies when visits ccur and dcuments the precise time services begin and end. Just like IVR, EVV will be used t schedule visits and submit hme visit claims t DHS. EVV will ensure that individuals are receiving the services authrized fr their supprt and fr which DHS is currently being billed. Yur emplyees will be required t call a tll free number when they initiate the hme health r case management services t the member and again upn cmpletin. The tll free number will be prvided by Sandata during the training sessin. DHS has cntracted with Sandata Technlgies, LLC. t prvide the EVV system and prgram rientatin. There is n cst fr the EVV prgram t the individual r prvider agency. All claims assciated with the abve services frdhsadvantagemembersmust be submitted thrugh the Sandata EVV system. Sandata Technlgies, LLC. ( is pleased t prvide its market leading Santrax Telephny Electrnic Visit Verificatin System (EVV) fr DHS s EVV prgram, and welcmes yur agency t the Santrax implementatin prcess. The Santrax implementatin includes: Training materials and sessins t ensure the EVV prgram meets user needs. Agency specific tll free numbers fr attendant EVV calls. A web based EVV system t supprt agency administrative requirements such as scheduling and claims submissin. A tll free Custmer Service line t supprt EVV users questins. The benefit that yu will receive as a prvider will include: The assurance that yur ADvantage Members are receiving their authrized services as scheduled: With the EVV System, an electrnic visit authenticatin ccurs thrugh telephne calls validating the actual time, lcatin and caregiver. Real time field visibility Claims prcessing: Electrnic Billing Exprt is embedded directly in the system fr a streamlined prcess. A variety f Management Reprts that can assist yu with running yur business peratin. Again, prviders will cntinue t receive frequent cmmunicatin cncerning this transitin. Please adhere t the recmmended guidelines. If yu have any questins regarding the infrmatin prvided abve, please feel free t cntact us via Smarter Mail at: aauprviderquestin@aau.kdhs.rg August 8, 2014 MSU Update: IVR/EVV Transitin #7 Page 6