Section 5: Approving a Plan of Care………………………… 5.1
Contents
1. Dare rei amd item nim al id pain i Use the scroll bar on the right hand side of the window to scroll to the Indicator questions The Indicator field will contain questions specific to the waiver program If the answer to the question is Yes click on the box If the answer to the question is No leave the box blank It is important to always view these questions because they may change Note that the Status field 15 gray and 15 unable to be updated by a case manager This field is only available to HCBS approvers Monthly Cost box will fill as the Plan is completed Total Client Obligation box will automatically fill based on information received from the SRS eligibility file This is the most current information the eligibility worker has entered You may not have received a notice from the eligibility worker yet because this field updates as soon as the SRS staff authorizes the client obligation change Further once it has been updated all claims will suspend until the new amount is assigned on the Plan of Care NOTE It is important to note that when SRS staff updates the Client Obligation in the eligibility files all claims for that time frame will suspend until the POC is updated with the new Client Obligation Revision Date 01 12 03 3 5 HCBS Plan of Care P2. 5 1 Kansas MMIS 2l Main Menu 5 2 T 5 3 Prior Authorization 5 4 Prior 5 5 Internal Text 5 6 PA Plan of Care 5 7 Plan of Care Maintenance Web 5 9 Plan of Care Maintenance Web Notes 5 12 Plan of Care Maintenance Approval 5 13 Viewin C Paim E 5 14 Revision Date 01 12 03 li HCBS Plan of Care Prior Authorization Manual Section 6 LOGO ii ish eet eros ve uUo RAPERE RM 6 1 Appendix A County 7 1 Appendix B Benefit 8 1 Appendix C Transaction Error Codes 9 1 Appendix D sei oio PE EAR eH 10 1 Revision Date 01 12 03 iii HCBS Plan of Care Prior Authorization This Page intentionally left blank Revision Date 01 12 03 HCBS Plan of Care Prior Authorization Overview Section One Introduction Welcome to the Kansas Medical Assistance Program s Home and Community Based Services HCBS Plan of Care System The Plan of Care System 15 used to electronically e
3. 212 226 olde ta fm gap nane OR LC trai flee ime qr nor daa Oo pm OR Pe Pe HR d Bau INE See n r Cuna m md REAL Aea DARRAIOLA feme jene fpem gt Client Obligation may be changed here Make any changes as appropriate Please refer to Section 4 Changing an Existing Plan of Care of this manual for specific instructions in making changes Revision Date 01 12 03 5 11 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance Notes jean of Care Linbenance Internet peneidecd by EOS EOE Edt Yew Took Help daBwk o D oz eh e 09 Br d om e Address f hiipi 23 212 225 201 Provider Pare ne Maint cep iniemel Kote Lires Harris Due Cher Approvers make comments to the Plan when accessing it from the website as well as from the Prior Authorization window in Production To add notes and comments click on Notes on the left This will bring up the Internal Note Field Notes appear in chronological order with the most current note at the bottom Highlight the last entry in the Notes fi
4. Plan of Care Prior Authorization User Manual HCBS Plan of Care Prior Authorization Table of Contents Section 1 1 1 Section 2 Logging onto the Web Site 2 1 Welcome to KMAP 2 1 The Provider Home 22 Login WiINGOW 2 3 Account Maimtenane is 2 4 Ee Mall BOX ouo 25 Section 3 Submitting a New Plan Of Care 3 1 PIA ob mte SUA ord ele side 3 Plan of Care 222 Plan of Care Maintenance Indicator Questions 3 5 Plan of Care Maintenance Line Items 3 6 Plan of Care Maintenance Notes 3 10 Plan of Care Maintenance Client Obligation 3 11 Isetuttito SearchiSCEeellie 3 13 Section 4 Changing an Existing Plan of Care 4 1 Plan Or Gare 4 1 Care Seare MEER OMS MORE 4 2 Plan of Care Maintenance Changes 4 6 Plan of Care Maintenance Changes Line Items 4 9 Plan of Care Maintenance Changes Notes 4 11 Plan of Care Maintenance Changes Client Oblig 4 11 to Search Sereeti us ss cres ERE CERE 4 13 Section 5 Approving a Plan of
5. Dinbi Leu E Penn Lig Chi Hates Era HOS Hoi gen EAT pane raul Denon Hil pnm Emm sae pH CX Pree A Fave pri S BELT FEES 489 9 E0900 Fo pean mats Ea kr The plan will appear As of October 2003 all Plans of Care cover a time span rather than one POC for one month Plans will not roll over to create a new Plan for the next month Rather one Plan will remain in effect for the entire time from the Effective Date through the End Date Review the current information Any changes will be made on the Plan of Care Maintenance window by entering the Reviewer s code in the Reviewer box and scrolling down into the body of the Plan Revision Date 01 12 03 4 6 Field Descriptions Case Manager Name Telephone Agency Provider ID Name Agency Phone Beneficiary ID Program Date of Birth Sex Deinstitutionalized Diverted Last Name First Name Middle Init Living Arrangement Level of Care SSN Revision Date 01 12 03 HCBS Plan of Care Prior Authorization Manual This 1s the identification number for the case manager assigned to the Plan of Care This field auto fills with the name of the case manager assigned to the Plan of Care This
6. Revision Date 01 12 03 4 10 HCBS Plan of Care Prior Authorization Manual Notes Once the POC has been submitted the status will default to EVALUATION It is also recommended that once the Plan has been submitted the screen should be refreshed before making any changes This will help Users avoid error messages Users may do that by going to the Kansas SRS banner at the top of the screen move the cursor over Plan of Care and click on Inquiry Using the search screen enter the beneficiary s ID to pull up the existing Lt All changes to the Plan should be documented in the notes section Highlight the word Notes any internal notes will appear Click on Add Enter the date the User s ID and add test Click on Line Items when the note is complete Changing Client Obligation To change the client obligation begin by scrolling up to the Total Client Obligation field and highlight the Client Obligation line month to be assigned Scroll down to the Client Obligation Provider Line Items field and click on the Servicing Provider field in the lower box Enter the nine digit provider number Tab to the next field to enter the provider s alpha location code using upper case letters Note information being entered will appear in the field above Revision Date 01 12 03 4 11 HCBS Plan of Care Prior Authorization Manual Enter the
7. HCBS Plan of Care Prior Authorization Manual Eligibility Benefit Plan Effective Date End Date Type of Review Reviewer Revision Date 01 12 03 Reference Appendix D This field represents the start date of the benefit plan This field represents the end date of the benefit plan This field represents the type of review 15 initial and is used for the initial Plan of Care for a beneficiary T will only be used once per beneficiary A is annual and is to used at the regularly scheduled annual re assessment of the beneficiary is for revised and is to used to make a revision at any time other than the initial or annual Plan of Care This field represents the ID of the person that 1s assigned to review the Plan of Care 4 8 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance Changes Line Items Units and or dollars may be increased at any time Users should decrease units and dollars only after checking with the HCBS Help Desk 785 274 5961 or their Approver to determine the change will not effect any paid claims A future enhancement will allow Users to view used and remaining dollars units at this window FA Pian of Core isin rid Late Ge 6 00 iE daat HALON Eee cn In the above example the User needed to change the total dollars allowed for Line items B amp D An end date of 10 31 03 was entered and then line items C amp E were added Line item A
8. HCBS Plan of Care Prior Authorization Manual If a line has been entered incorrectly it may be removed by using the Remove button on the right Highlight the line to be removed and click on the Remove button At this point carefully review the information on the Plan of Care If information 15 correct Users must click on the Submit button to save information Do not repeatedly click on Submit until you receive either a Successfully Saved or Unsuccessfully Saved message In some cases doing so has created extra If an error has been made while entering the Plan of Care Users will receive an Unsuccessfully Saved message The error must be corrected before continuing See Appendix C for Transaction Error List or call the HCBS Help Desk for more information It is also recommended that once the Plan has been submitted the screen should be refreshed before making any changes This will help Users avoid error messages Users may do that by going to the Kansas SRS banner at the top of the screen move the cursor over Plan of Care and click on Inquiry Using the search screen enter the beneficiary s ID to pull up the existing Once the Successfully Saved message appears the User may continue on to the next Plan of Care or log off of the system Field Descriptions Servicing Provider This field represents the provider number of the provider who 15 responsible for collecting the client obligation Requeste
9. ID Name Agency Phone Beneficiary ID Program Date of Birth Sex Revision Date 01 12 03 This 1s the identification number for the case manager assigned to the Plan of Care This field auto fills with the name of the case manager assigned to the Plan of Care This field auto fills with the phone number for the case manager assigned to the Plan of Care This 1s the code that represents the responsible agency for this Plan of Care This field auto fills with the provider ID number corresponding with the responsible agency for this Plan of Care This field auto fills with the name of the agency responsible for this Plan of Care This field auto fills with the responsible agency s phone number This field represents the identification number for the beneficiary This 1s the assignment code that identifies the waiver program This field auto fills with the beneficiary s date of birth listed on the SRS eligibility file This field auto fills with the beneficiary 5 sex code listed on the SRS eligibility file 3 3 HCBS Plan of Care Prior Authorization Manual Deinstitutionalized This field is checked for beneficiaries who were in an institution immediately prior to entering waiver services Diverted This field 1s checked for beneficiaries who are entering waiver services from the community Last Name This field auto fills with the beneficiary s last name from the SRS eligibility file First Name This field auto
10. case letters for the User ID lower case letters for the password If the User has not received a User ID contact the fiscal agent before proceeding Once the User ID amp password has been entered click on the Log On button Microsoft Internet Explorer e The initial password is a one time password and the User will immediately be prompted to change their password Click OK Revision Date 01 12 03 2 3 HCBS Plan of Care Prior Authorization Manual Account Maintenance ETAT MIDI IZ S4 inivrnei i Leer i l OI Assistance E made 17 fore Pe 12 80 amu E paix Account Maintenance The Account Maintenance window will allow Users to change their password and update the User ID information Click the SUBMIT button Revision Date 01 12 03 2 4 HCBS Plan of Care Prior Authorization Manual The Mail Box lec eel De a TNI T E 1 c um GE so c Qu bo see jee peran 2121 mU Geechee Fa 2832 pr You have successfully logged on fo secure website fcu 1 ober M 2 ve s m ES d Roni aud xr
11. gt and re submit 1003 many characters in value Change the value of lt fname gt and re submit 1004 init select fields No search criteria specified Change the value of fname and re submit 010 1 PatientLiab Field value is missing Change the value of patientLiab and re submit 1011 Recipient Missing recipient Add a recipient and re submit 1012 Provider Missing provider Add a provider and re submit 1013 patient liability Change the value of patientLiab and re submit 1014 PatientLiab Dates out of range The dates specified for the obligation are out of the range of the dates of patientLiab Change values for patientLiab dateEffective or dateEnd and re submit and re submit Revision 01 12 03 9 1 HCBS Plan of Care Prior Authorization Manual 1016 DateEnd Invalid date range The obligation ending date is earlier than the effective date Change the date range and re submit 1017 DateEnd Date of of range of line item The obligation end date is later than the detail s authorized end date Change the value of the obligation dateEnd and re submit 1018 DateEffective Missing or invalid date Change the value of the obligation dateEffective and re submit 1019 DateEffective Date out of range of line item The obligation effective date is earlier than the detail s authorized effective date Change the value of the obligation dateEffe
12. that the case manager requests that the services start Requested End Date This field represents the date that the case manager requests that the services end Requested Units This field represents the number of units per calendar month for the service requested by the case manager Revision Date 01 12 03 3 8 HCBS Plan of Care Prior Authorization Manual Requested Dollars Payment Method Authorized Effective Date Authorized End Date Authorized Units Authorized Dollars Servicing Provider Revision Date 01 12 03 If both dollars and units were entered this field represents the tier rate for the beneficiary If only dollars were entered this field represents the dollar amount per calendar month for the service requested by the case manager This amount may be prorated for a partial month This field represents the approved date for the service to start This field represents the approved date for the service to end This field represents the approved number of units per calendar month for the service If both dollars and units were entered this field represents the approved tier rate per calendar month for the service If only dollars were entered this field represents the approved dollar amount per calendar month for the service This field represents the provider number of the provider who 15 approved to perform the service 3 9 HCBS Plan of Care Prior Authorization Manual Plan of Care Mainte
13. the Plan use the HCBS Web button at the bottom of the screen However if the Approver is making a change the Status on the PA Plan of Care Maintenance screen must be Evaluation BEFORE making the change on the HCBS Web This seems to cause fewer errors to occur Revision Date 01 12 03 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance Web Thee wp 1 Agee JD Plan of Care Maintenance Agnes s we This is the screen the Case Manager used when entering the POC Revision Date 01 12 03 5 9 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance Web Continued LAT Hn a eran ets LO ae a eon Te are d d aub s Dre deine ep rdr hs a aE 7 ron rri zaras lOc f Lil sin ee TE ed 1 meet 0 2 gee eee pe eee Jmm Line Items may be changed here Make any changes as appropriate Please refer to Section 4 Changing an Existing Plan of Care of this manual for specific instructions in making changes Continue to scroll down through the Plan of Care Revision Date 01 12 03 5 10 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance Approval Continued pe kjai EI fe gy LE Je Pasa ah ers c to deeem G oy ME
14. using the above requirements TAB to Dollars and again using the above requirements enter dollars as appropriate Revision Date 01 12 03 3 7 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance Continued TAB to Payment Method field If the User entered e Units use the drop down arrow to choose Pay System Calculated Price Dollars use the drop down arrow to choose Cap Amount e Units and Dollars use the drop down arrow to choose Pay PA Unit Fee TAB to Servicing Provider field and enter the nine digit provider number for provider performing this line item procedure Tab to the next box to enter the provider s alpha location code in upper case To add additional services highlight the last entry in the Line Items box click the ADD button and the Line Item field will empty to allow the User to enter the next service If line items need to be removed for this Plan highlight the line by placing the cursor on the line to be removed and click on the Remove button on the right Field Descriptions Item This field represents the alpha character itemizing the individual service on the Plan of Care Each service has a unique line item character Procedure This field represents the code identifying the procedure being requested Modifier This field represents the modifier needed on some procedures This field can be left blank if not relevant Requested Effective Date This field represents the date
15. 4 Pay System Price 2003 04 28 2003705728 7 00 2003 01 701 2003701730 1002079504 Pay System Price 2003 04 01 2003704730 0 00 2003 01 701 2003 01 730 1002079504 Pay System Price Client Obligation Honth Service Provider 2003 04 1002079504 2003 04 1002079504 2003704 100207950 l Hew Show Modified HCBS web Exit Return to the POC Maintenance window to change the status of the POC Always refresh the window to insure the changes appear To refresh the window Users may click on the EXIT button at the bottom of the screen to close the POC Maintenance window Once at the Prior Authorization window click on the Line Item button This will refresh the POC Maintenance window so that any changes are included Use the Status drop down box to make this change Always click Save before closing the window Revision Date 01 12 03 5 13 HCBS Plan of Care Prior Authorization Manual Viewing Paid Claims Prior Aer each Ane I NEM Parenter L Location Sanata Prrveder E Larmia 1 le eee Mannger County Semen L meten S j Fe Dot Pei e a As part of the approval process Approvers will occasionally need to review paid claims These can be viewed by returning to the Prior Authorization History screen Highlight the Plan to be reviewed and click on the Claims button at the
16. Date 01 12 03 3 13 HCBS Plan of Care Prior Authorization Manual Notes Revision 01 12 03 3 14 HCBS Plan of Care Prior Authorization Manual Section Four Changing an Existing POC Plan of Care Inquiry Finami 1832172 143m Plan ef Care DX BET 212 772 er eo gar eee apego itemm een tare i changes and updates will be completed using the Inquiry option Click on Inquiry Revision 01 12 03 4 1 HCBS Plan of Care Prior Authorization Manual Plan of Care Search LE d NES I he aH a ea 5 rop cud diee atem dete ab Cd ol 88 iiim WE her Zu 27 oria i e HIC RE eim m 18217 Bonelli ADEN LR bU hia Date Plan of Care Search Program 5 Coury J Sasa Ewan pee 2 po pees qa cae Searc hing can be as broad or as narrow as desired The more fields that are completed the more specific the search results However at least one of the following must be used Beneficiary ID number Beneficiary Agency amp Status Case Manager amp Status Reviewer amp Status For example to check a workload for a sp
17. Effective Date End Date and Client Obligation Amount in the appropriate fields If the beneficiary has different Client Obligations for different months Users must scroll up to the Total Client Obligation box and highlight the next Client Obligation line month and then scroll back to the Client Obligation Provider Line Items in order to enter the next Client Obligation If the Client Obligation has been entered in error highlight the incorrect line and click on the Remove button on the right When entering the end date on the Plan use the same end dates as used for the Line Items If the client obligation has changed to 0 00 enter an end date for the previous line and nothing further needs to be done Always Submit after removing a line After submitting always refresh screen before making additional changes Field Descriptions Servicing Provider This field represents the provider number of the provider who 15 responsible for collecting the client obligation Requested Effective Date This field represents the date that the case manager requests that the services start Requested End Date This field represents the date that the case manager requests that the services end Requested Amount This field represents the dollar amount that the client is responsible for paying to the service provider each month within the requested dates Plan of Care Status Info This field represents the current status of the Plan of Ca
18. and the cursor will not stop in that field Once at the Plan of Care screen remember to either TAB or use the mouse to move from field to field Using the ENTER key may delete data that was just entered Revision Date 01 12 03 1 2 HCBS Plan of Care Prior Authorization Manual Section Two Logging onto the Web Site KMAP Welcome Window The only way to access the Plan of Care system is through the Kansas Department of Social and Rehabilitation Services KMAP website Using any Internet server provider the User will enter the KMAP website address https www kmap state ks us The following window will appear kinta Welcome to KMAP Kansas Medical Assistance Program Website The HMAF hrath and mui cal poscy qmremminonio bocwntaenez and proderz Chat Vision ie qo anam e rw hi quill halte gre regarde Tee abbr I egy tene The Bas inf rmmabon he Kane Media Azziziaca Program To get a mera detarked of topics cack on tg 180 Presider The Provider Section hae infomation geared invent potential or kadgod proades To gat more jailed ising of jocics itk on Ihe Pron der tab Dot Lawi Made Azelf For convenience the User may click on the website address at the top of the window and drag it to their desktop to create a KMAP Icon This will a
19. anhattan Area Office Kayla Paige Olathe Area Office Danny Hewett Topeka Area Office Kirk Maher Wichita Area Office Emily Gagnebin Marc Madden Revision 01 12 03 Resources 785 274 5961 785 274 4220 800 933 6593 620 431 5098 316 321 4200 620 272 5839 785 628 1066 X 264 620 663 5731 X 229 913 279 7689 785 832 3885 785 826 8000 913 826 7577 785 296 0396 316 337 6350 316 337 6123 10 1 Kansas Medicaid Provider Representative Territorial Map PHLLE S 185 735 3590 ERST mark lt hee eds com 316 728 0018 xix heg eds cam Brenda Schurnacher sutan hicke hog ads com Jody Carlisle 765 626 8648 PHE 274 5b968 brenda heg eds eam heg ecds com Carne Maare 5 Lisa Cushing 218 729 9781 1 Linda Burgess Esa hcg eds com linda burgesses beg eds com Roxanne Alexander C Ruth Wiliams PEU DEAE STO 216 283 217
20. bottom of the screen Revision Date 01 12 03 5 14 HCBS Plan of Care Prior Authorization Manual Claims List Claims List Ciam Pumie PA Line tem 4003201043097 400 22 81 243541 A window similar to the one above will appear All claims associated with the Plan of Care will appear here with the Internal Control Number ICN and the Line Item from the POC If a scroll bar appears on the right hand side of the window scroll down to view additional entries Double click on the Claim number to view the claim Please refer to the 1CMMIS training manual for assistance in reading claims Use the Exit button to remove this window and return to the Prior Authorization window Revision Date 01 12 03 5 15 HCBS Plan of Care Prior Authorization Manual Section Six Logoff Use the Exit buttons at the bottom of each screen to exit the individual screens Main Menu PRODUCTION Clicking on the EXIT Application button on the Main Menu will log Approvers out of Kansas MMIS Production Revision 01 12 03 6 1 HCBS Plan of Care Prior Authorization Manual Appendix A Kansas County Codes AL AN AT BA BU CS CK CN CA CY CD CF CM CL CR DC DK DP DG ED EK EL EW FI FO FR GE GO GH GT GY Revision 01 12 03 Allen Anderson Atchison Barber Barton Bourbon Brown Butler Chase Chautauqua Cherokee Cheyenne Clark Clay Cloud Coffey Comanche Cowley Crawford Decatur Di
21. ckinson Doniphan Douglas Edwards Elk Ellis Ellsworth Finney Ford Franklin Geary Gove Graham Grant Gray Greeley GW Greenwood HM Hamilton Harper Harvey HS Haskell HG Hodgeman JA Jackson JF Jefferson JW Jewell JO Johnson KE Kearney KM Kingman KW Kiowa LB Labette LE Lane LV Leavenworth LC Lincoln LN Linn LG Logan LY Lyon MN Marion MS Marshall MP McPherson ME Meade MI Miami MC Mitchell MG Montgomery MR Morris MT Morton NM Nemaha NO Neosho NS Ness NI Norton OS Osage OB OT PN PL RS SA SC SG SW SN SD SH SM SF ST SV SU TH TR WB WA WS WH WL WO WY Osborne Ottawa Pawnee Phillips Pottawatomie Pratt Rawlins Reno Republic Rice Riley Rooks Rush Russell Saline Scott Sedgwick Seward Shawnee Sheridan Sherman Smith Stafford Stanton Stevens Sumner Thomas Trego Wabaunsee Wallace Washington Wichita Wilson Woodson Wyandotte 7 1 HCBS Plan of Care Prior Authorization Manual Appendix B Benefit Plans Revision 01 12 03 Aids Drug Assistance Program Full Benefits Aids Drug Assistance Program Tracking Only Expanded LMB Stand Alone Foster Care Adoption Foster Care Foster Care Severely Emotionally Disturbed Family Preservation HCBS Developmentally Disabled HCBS Frail Elderly HCBS Head Injury HCBS Physically Disabled HCBS Severely Emotionally Disturbed HCBS Technology Ass
22. ctive and re submit 1020 ClientObligationProv Unknown provider liability The patient liability provider could not be found Change the liability values and re submit re submit submit amount submit 1024 IdClerkEntry Missing or invalid id Change the id and re submit 1025 Indicator Missing or invalid indicator Change the indicator and re submit 1026 User_agency Invalid agency for clerk Change the agency and re submit 1027 AmtPaReq Total cannot be less than amount Change the amount s and re submit used 1028 PaReqEff Date below date of service Change the date and re submit 1029 UntSvcReq Total cannot be less than the Change the unit s and re submit RN 1030 Procedure Benefit not covered for item n Change the procedure or have the pes LEE 1o PITE 1031 1032 1033 Assignment Code Beneficiary not eligible for hange the assignment code and re ee requested 1040 dateEffective Provider Obligation start date is hange the date and re submit we een be the first day of the month 042 dateEffective Provider Obligation start date is hange the date and re submit before the Client Obligation start 1 1043 dateEffective Provider Obligation start date 15 hange the date and re submit fter the Client Obligation end T 1044 dateEnd Provider Oblig end date must be hange the date and re submit month end or same as Client Oblig 1045 Delete deta
23. d POC will be entered This Plan of Care is pending waiting for review by the Approver This 1s not used in the current Plan of Care system This will be used when a Plan of Care has been sent back to the case manager for changes This 1s the identification number for the case manager assigned to the Plan of Care This field represents the two digit county code in which the beneficiary resides This field represents the approved start date of the Plan of Care 4 3 HCBS Plan of Care Prior Authorization Manual Plan of Care Search Continued 2 1 dex gem aay 1 2811116 Plan af Care Search Berac gano 30000006 Pond ursi C sj PA Status Cue haar Deals 7j Agancy Ravi PA End Naisi Code Caso Managar ey Program indicator Statue ee TY A Push To ng HOO Pw TI TE HER TIS LIEFE Dd Fue ZH After clicking on the Search button all plans meeting the search criteria will appear below the Search button When Previous or Next appears in bright blue print at the bottom of the screen Users may click on the word to move forward or backwards through the list Once the desired POC has been found place cursor on th
24. d Effective Date This field represents the date that the case manager requests that the services start Requested End Date This field represents the date that the case manager requests that the services end Requested Amount This field represents the dollar amount that the client is responsible for paying to the service provider each month within the requested dates Plan of Care Status Info This field represents the current status of the Plan of Care Revision Date 01 12 03 3 12 HCBS Plan of Care Prior Authorization Manual Return to POC Search Screen TR eran ol Care SeoneeoTE Deiternet Explorer by EDS CUTE EE E E Edt Paecrten Tool fuck OE A Arh boue S m 59 Address 2 212 275 201 Provider Parse DOPO ar 179 Links dE customi Links BEDS Infocertre Wadnasdae 123 Augiual 2 32 Plan O amp K Care Maintenance Pian af Cmrm Maneger xz hara Anoy x Bowen T Benet 6 m sz 0 sex 0 Dci zd sess _ Diari Lact Mama mie n isarate a Benefit Plan Garin Pred Tee arReview To return to the Search Screen click on Plan of Care found in the banner at the top of the screen Two options are given Inquiry or Submit Choose one Revision
25. e MMIS Login Frequently Asked Questions and Provider s Rights to Appeal information Providers may access this information at any time For purposes of using the Plan of Care system click on MMIS Login Revision Date 01 12 03 2 HCBS Plan of Care Prior Authorization Manual Logon Window 4 ii ict JE IM eit eo 9227 ni 3 11 Aaa 2011137 am The Kansas Medical Prooram s secura wabsita is intended for providers clerks ant hing Acces o mes a Prid dor tel sccess ora user ICuparsword For iomain on obtaining Fi pase Leo EAR D a ET elem This sie gres you the cpocrtunty io sies dam iyi claim summary prior oe amd ciam summae Also you messages from SES thet speri csi bo yoo you are siearty g member Hairi scar pleas entar he ifcmabon below do ener Gof secure Thes wena 4 compamie viti Explorer vein 5 ar e ony You may Inigmer Expkrar from Falke ng Airmmdy member Lag onto secure website Fa pnr The KMAP Secure Website logon page will appear If the User has received a User ID and temporary password from the fiscal agent enter that information in the Already a Member section The log in ID and password are case sensitive Use upper
26. e PA Number field and click once Revision Date 01 12 03 4 4 HCBS Plan of Care Prior Authorization Manual Field Descriptions P A Number Agency Case Manager Beneficiary Program Review Indicator PA Status Effective Date End Date Revision Date 01 12 03 This field represents the number assigned to a Plan of Care after it has been submitted for approval This field represents the responsible agency for this Plan of Care This field represents the identification number for the case manager assigned to the Plan of Care This field represents the identification number for the beneficiary This field represents the assignment code that identifies the waiver program This field represents the type of review This field represents the current status of the Plans of Care This field represents the approved date for the service to start This field represents the approved date for the service to end 4 5 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance Changes oh ar of tare ET ADT icrasext Dre Erie ED COE Fi m vara Too Fep sack re 2 EIN da Oy 153 2003 pm Plan of Care Maintenance p Pat Cw MATS DL o E CR A n Apie ET m s bsc af
27. ecific case manager for a specific program fill the Case Manager and the PA Status fields and click on the Search button Another example would be to check all plans in Evaluation status for a specific agency fill the Agency and PA Status field and click on the Search button Users should frequently check for any Plans Rejected status These POC have been submitted to the Approver but were rejected for a specific reason They require the User s attention and can be resubmitted to the Approver after responding to the problem Revision Date 01 12 03 4 2 HCBS Plan of Care Prior Authorization Manual Remember that only Plans of Care that are assigned to the User s agency will be available for viewing Field Descriptions Beneficiary Program Agency Reviewer Review Indicator PA Status Approved Cancelled Evaluation Modified Rejected Case Manager County Start Date Revision Date 01 12 03 This field represents the identification number for the beneficiary This is the assignment code that identifies the waiver program This 1s the code that represents the responsible agency for this Plan of Care This field represents the ID of the person assigned to review the Plan of Care This field represents the type of review I 2 Initial Review Annual This 1s used when Plan of Care has been approved for payment This may be used when a Plan of Care has been 1s in error Often a new correcte
28. ecord must be entered into the database 2005 PaIntText Record not found The internal text record is not available The missing record must be entered into the database pa specific error message Change the value of lt fname gt and re submit 9001 CONNECT database specific error message Report this to the system administrator message should be reported message should be reported message should be reported 9010 Process obligations database specific error message attribute and the database Mere Revision Date 01 12 03 HCBS Plan of Care Prior Authorization Manual jshouldbe reported should be reported should be reported should be reported should be reported should be reported should be reported should be reported should be reported should be reporte should be reported should be reported should be reported should be reported When reporting errors include all of the information from the message Revision Date 01 12 03 9 4 HCBS Plan of Care Prior Authorization Manual Helpful Phone Numbers HCBS Help Desk New User Applications EDS Security Provider Assistance Customer Service Medicaid Liaisons Chanute Area Office Rita Stapleton Emporia Area Office Beth Gates Garden City Area Office Mary Calzonetti Hays Area Office Gayle Hanson Hutchinson Area Office Cindy Proett Kansas City Area Office Monica Sipple Lawrence Area Office Michelle Swain M
29. eld Click Add The Internal Note field will empty of any previous information and the Approver may then indicate the line item the note 1s specific to the date the note 1s being entered and the ID of the approver entering the notes Tab to the Text Field and enter notes information The Text Field is limited to 500 characters per note Click Line Items on left to go back to Plan of Care Maintenance Screen Always select the Submit button before leaving the Plan of Care This will ensure that the information that has been added changed has been updated Revision Date 01 12 03 5 12 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance Approval Plan of Care Maintenance File Edit Applications PA Number 002003091001 Beneficaty ID A033702 02 Beneficar Name DRY NAOMI G Program HCBS PD DENEN Agency Agency Case Manager Case Manager Review Reviewer Status Code Phone Name Phone Ind 12345678 785 827 3383 19999999 501 366 6555 ARBRRTx Total Monthly Cost Waiver Indicator Waer Ind Criteria DOES PLAN INCLUDE SUPPORTI VE HOME CARE IF SERVICE BILLED AT DAILY RATE SELECT Requested Authonzed Service Service Dates Units Dates Amount Provider Price Method 0080 2003 04 03 2003 05 03 5 00 2003 04 01 2003 04 30 0 00 1002079504 Pay System Price 2003 04 15 2003 05 15 0 00 2003 05701 2003705731 1002079504 Pay System Price 2003 04 30 2003 05 31 56 00 2003 06 01 2003706730 100207950
30. field auto fills with the phone number for the case manager assigned to the Plan of Care This 1s the code that represents the responsible agency for this Plan of Care This field auto fills with the provider ID number corresponding with the responsible agency for this Plan of Care This field auto fills with the name of the agency responsible for this Plan of Care This field auto fills with the responsible agency s phone number This field represents the identification number for the beneficiary This 1s the assignment code that identifies the waiver program This field auto fills with the beneficiary s date of birth listed on the SRS eligibility file This field auto fills with the beneficiary s sex code listed on the SRS eligibility file This field 1s checked for beneficiaries who have been in an institution at some point This field 1s checked for beneficiaries who have never been institutionalized This field auto fills with the beneficiary s last name from the SRS eligibility file This field auto fills with the beneficiary s first name from the SRS eligibility file This field auto fills with the beneficiary s middle initial from the SRS eligibility file This field auto fills with the Living Arrangement from the SRS eligibility file This field auto fills with the Level of Care Code from the SRS eligibility file This field auto fills with the beneficiary s Social Security Number from the SRS eligibility file
31. fills with the beneficiary s first name from the SRS eligibility file Middle Init This field auto fills with the beneficiary s middle initial from the SRS eligibility file Living Arrgmt This field auto fills with the Living Arrangement Code from the SRS eligibility file Level of Care This field auto fills with the Level of Care Code from the SRS eligibility file SSN This field auto fills with the beneficiary s Social Security Number from the SRS eligibility file Eligibility Benefit Plan Reference Appendix D Effective Date This field represents the start date of the benefit plan End Date This field represents the end date of the benefit plan Type of Review This field represents the type of review is initial and is used for the initial Plan of Care for a beneficiary T will only be used once per beneficiary A is annual and is to used at the regularly scheduled annual re assessment of the beneficiary R is for revised and is to used to make a revision at any time other than the initial or annual Plan of Care Reviewer This field represents the ID of the person that 15 assigned to review the Plan of Care Revision Date 01 12 03 3 4 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance Continued Indicator Questions wh r vn DOES AEH 1 Dicere
32. il Unable to delete detail claim A detail cannot be deleted if there any information found n n laims against it 1046 clientObligationProv Unable to delete obligation pecify a valid obligation nknown provider liability 9 2 Revision Date 01 12 03 HCBS Plan of Care Prior Authorization Manual 1047 gt to delete detail detail not Specify an existing detail found n 1048 Svc overlap 7 l Overlapping procedures n and n 1049 Check prov duplic Overlapped obligation for hange the date and re submit 1050 Procedure Benefit is not a known covered hange the procedure and re submit 1051 Procedure Benefit is not for an HCBS hange the procedure and re submit dates specified item benefits item recipient s eligibilties 1054 Procedure Recipient is not eligible for Change the date range and re submit for the date specified item specified benefit item found 2001 clientObligationProv Missing patient liability for The missing data must be entered into the details database NumPaLineItemDtl Record not found The line item detail record is not available The missing record must be entered into the database 2003 NumPaLineltem Record not found The line item record is not available The missing record must be entered into the database 2004 priorAuthorization Record not found The prior authorization record is not available The missing r
33. isted HealthConnect Hospice HealthWave 19 Dental HealthWave 19 Medical HealthWave 19 Mental Health HealthWave 21 Dental HealthWave 21 Medical HealthWave 21 Mental Health Punitive Lock In Low Income Medicare Beneficiary Dual MediKan Medically Needy Program of All Inclusive Care for the Elderly Qualified Medicare Beneficiary Qualified Disabled Working Individual Stand Alone Sixth Omnibus Bill Reconciliation Act Tuberculosis Title XIX Title XXI MCO or Title XXI 8 1 HCBS Plan of Care Prior Authorization Manual Appendix C Error Codes Transaction Error List Error Range 1 999 General errors that prohibit the application from running 1000 1999 Data edit validation errors The data may be changed and re submitted 2000 2999 Data retrieval errors The data found the database doesn t fit the defined data model The database must be corrected to get past this error 4000 4999 Prior Authorization s data edit validation errors These errors are returned by the validation routine for prior authorizations The data may be changed and re submitted 9000 8999 Internal configuration errors Report these errors to EDS 9000 9999 Database errors Report these errorsto EDS Code 1 db connect Unable to connect to database Additional error messages may provide more information Report this and all other messages to the system administrator submit 1002 Fname Invalid date Change the value of lt fname
34. lient Obligation Month Service Provider 2003 04 1002079504 2003 04 1002079504 2003704 1002079504 Hew Show Modified 5 Web Exit Approvers may view the Plan of Care in its entirety from this window The window includes the PA Number Bene ID amp Bene Name Program Waiver the Agency Code amp Agency Phone Case Manager Data Entry Clerk s ID Name and Phone Review Indicator Reviewer s name Status of the Plan of Care Total Monthly Cost Waiver Indicator Questions the services to be authorized Line Items and Assigned Client Obligation Revision Date 01 12 03 5 7 HCBS Plan of Care Prior Authorization Manual PA Plan of Care Maintenance continued Note that the Total Monthly Cost the Waiver Indicator questions and the Client Obligation fields have scroll bars on the right hand side when additional information 15 available Highlight the month to be viewed in the Total Monthly Cost box line items associated with that month will appear in the Line Item box Line Items can be identified by the procedure code and are divided in sections as Requested and Authorized Approvers will use the drop down options in the Status field to approve reject or cancel Plans of Care Only use the cancel option when the whole Plan 1s invalid Plans of Care cannot be deleted Other options in the drop down box are for use by the fiscal agent and not applicable to HCBS Plans of Care To make a change in
35. llow for quick and easy access when going to the website Click on Provider Revision Date 01 12 03 2 1 HCBS Plan of Care Prior Authorization Manual Provider Home Page Jm iler Fons l eiert 2 konigi Medical ma ne HEALTH kanisa Welcome to the Provider Home Page i5 the Proader Home Page of fe Kansas Acsisiance Program The purpose Of this page pride mamao lore ened mole necesse for tnus k manusis geared do da pravider Prowtders il Fart access 30 Curent ar neon cal rite ds bm and Fspom sl budepns tor presens Fons un fecha Pme saminer bets minutes Eom Provider Task Fone Meetings The AES Login secion trareferns you the Kansas Medica Azzzance Frognam HMAF Secum etse Where aulhonzed prad r osn miiy boul their clans and venty mambar aboibilre quickky and cary For obcaiein an sae Ache Questions ic documents your rights ri appeal a denial notice A variety of information is available from the Provider Home Page From this page Users may access Provider Manuals Bulletins Provider Enrollment forms Ancillary Documentation Workshop Schedule Task Force Meeting Minutes Th
36. m puri of pru Prcoexhr Agere wx Era hisdcud Tham mad Hrs pobiczbecr and keep Eee E ea ap Pe Bee Jomtien Gert Comer mi 23 5593 121 123 elect there mU Ac When the log on sequence 15 complete the window above will automatically appear It will display any new messages received and creates a bulletin board for important messages from SRS They are informational read only messages and are not specific to any Plan of Care When the Mailbox is selected from the menu bar the title of the screen changes to Mailbox with all messages displayed that have not reached the end date Click on Next Revision Date 01 12 03 2 5 HCBS Plan of Care Prior Authorization Manual Notes Revision Date 01 12 03 2 6 HCBS Plan of Care Prior Authorization Manual Section Three Submitting a New Plan of Care Plan of Care eter cu d Zee utem ee 11 pe ee reudi Ded eee A 1T 1832172 143m Plan ef Care Dr FATE 212 275 eee rari e a Local miran I e a a seem omen famae Yyperm 1 inm At the Plan of Care window Users will click on the Submit button NOTE The Inquire button will be used for reviewing changing and updati
37. nance Notes Notes adi il 242 31 P CO Dann ine ue jane geet gees T E 3 Sa a Fes om i i Every Plan of Care must be documented in the Notes field Click on Notes on the left This will bring up an Internal Note Field Indicate the date the note is being entered and the User ID of the clerk entering the notes TAB to the Text Field and enter notes information The Text Field is limited to 500 characters per note Click Line Items on left to go back to Plan of Care Maintenance Screen Field Descriptions Notes This field represents communication text between case manager and SRS approval staff pertaining to specific line items Line Number This field represents the line number of the line items it is an alpha code and is automatically filled by the system once the Plan has been submitted to the approver Date This field represents the date that the text was written Clerk This field represents the ID of the clerk that entered the internal notes Text This field represents the content of the communication Revision Date 01 12 03 HCBS Plan of Care Prior Authorization Manual Client Obligation T Hr ed Peedi Poe s rir umm Dor lm lai tam LAGE Use the scroll bar on the right hand side of the window to move down to the Client Obligation Provider Line Items field Client obligations will be assig
38. ned to specific providers using this area If there 1s no client obligation for the beneficiary this information can be left blank The upper box in the Client Obligation section act as a summary of the information that 1s added in the lower box If beneficiary has a client obligation begin by scrolling up to the Total Client Obligation field and highlight the Client Obligation line month to be assigned Make note of the amount Scroll down to the Client Obligation Provider Line Items field and click on the Servicing Provider field in the lower box Enter the nine digit provider number TAB to the next field to enter the provider s alpha location code using upper case letters Note information being entered will appear in the field above Type Effective Date End Date and Client Obligation Amount in the appropriate fields If the beneficiary has different Client Obligations for different months Users must always scroll up to the Total Client Obligation field and highlight the next Client Obligation line month and then scroll back to the Client Obligation Provider Line Items in order to enter the next Client Obligation The information that appears in the Provider Line Items box may appear or disappear depending on which line 1s highlighted in the Total Client Obligation field NOTE the Effective Date amp End Date entered for the Client Obligation must be within the dates of that specific Plan of Care Revision Date 01 12 03 3 11
39. ng all existing Plans of Care The Submit button will be used for all new consumers with new Plans of Care MRDD Users will also use the Submit button when entering an annual Plan of Care Revision 01 12 03 3 1 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance of Care FAaletenamor 0 Internet Explorer provided b EDS CUE 3 E Halip E Address hater 128 212 225 201 Provider Mare 2009 20C are Paint asp eGo Links dEjCustomirelnks 75 zio d Wadnasdag132849gusl 2 32 pim Plan of Care Maintenance r Poeni ar Caes Cure Manger Teh phone mx sex Dici ulia ses Diari Lact Mame m o Arii Level ef Cane Bernar Plan Stein Ered Tee Beate Please note that User IDs are tied to an Agency Code Users will be able to access only the Plans of Care that have their Agency s code in the Agency field Use the down arrow to choose the User ID for this field Note that the name and telephone field will automatically fill Future enhancements will include separate fields for data entry staff and case managers To select an agency click on the down arrow in the agency field most agencies will have only one option in this field These choices are based
40. nt Code and use the drop down box to find the appropriate waiver Click on the Search button Approvers will check their workload by entering their User ID in the drop down box in the Reviewer field and then tabbing to the Status field and choosing Evaluation Click on the Search button Approvers will view all Plans of Care that have been sent to them for approval Approvers can also review all Plans for a specific agency or for a case manager by entering the Agency or case managers number in the appropriate field and using the Status field Click on the Search button Revision Date 01 12 03 5 4 HCBS Plan of Care Prior Authorization Manual Once a specific Plan of Care has been identified Approvers may either double click on that line item or after highlighting the line click on the Select button at the bottom of the screen Prior Authorization Prior Authorization File Edt Applications Options DEDE Provider Provider Mame F Provider Phone Bene ID CH Beth Date TOBE FSS 1 Bene Hame ADAM Number 012002357003 Reviewer TE Review Date PA Assignment ADVANTAGE WAIVER pca Code C Date Received 2002 12 23 Media Type BNEIME Clerk Keyed YARBRRT Add info Req Date Date Keyed 2002 12 23 PCEM Hefesak F Analyst YARBART Date Mailed 2803 04 23 Print Option Image Inc Admin Review 7 tntema
41. nter and approve waiver services to allow claims payment It is accessed through the Kansas Department of Social and Rehabilitation Services SRS KMAP website and is used to authorize service This training material is specifically for the HCBS Waivers The Plan of Care system 15 linked to the electronic eligibility and payment system that is used by Kansas Medical Assistance Program to process claims Because the systems are linked the HCBS Plan of Care system can pull information from beneficiary SRS eligibility files This includes beneficiary name and eligibility provider names and numbers procedure code descriptions and pricing Once the designated State of Kansas HCBS Approver approves a Plan of Care POC the plan will allow claims that fall within the approved plan to be paid Claims must be submitted according to the Kansas Medical Assistance Program KMAP provider manuals for HCBS Waiver Services This manual includes instructions for use of the system helpful tips for using the system waiver specific information solutions to common problems and methods for making changes Revision Date 01 12 03 1 1 HCBS Plan of Care Prior Authorization Manual Before Signing On Usually but not always the cursor automatically appears in the field in which the User 15 to start typing Buttons will appear on each screen for options such as saving information and exiting the system Fields that are shaded cannot be updated
42. of the window to view all notes related to this Plan of Care Approvers must also note their actions at this window Click New and add the date the Approver s User ID and any comments about this Plan of Care Click Save and the Exit to return to the Prior Authorization window Once at the Prior Authorization Window click on Line Item see example of this window on page 5 5 to view the Plan of Care Revision Date 01 12 03 5 6 HCBS Plan of Care Prior Authorization Manual PA Plan of Care Maintenance PA Plan of Care Maintenance File Edit Applications Number 002003091001 Beneficary ID 4033702 02 Beneficary Name DRY NAOMI G Program HCBS PD Agency Agency Case Case Manager Case Manager Review Reviewer Status Code Phone Manager Name Phone Ind 12345678 785 827 3383 19999999 501 366 6555 ARBRRTx Total Monthly Cost Waiver Indicator Month Amount Waiver Ind Criteria DOES PLAN INCLUDE SUPPORTIVE HOME CARE IF SERVICE BILLED AT DAILY RATE SELECT Requested Authorized Service Service Dates Dates Amount Provider Price Method 0080 2003 04 03 2003 05 03 2003 04 01 2003 04 30 0 00 1002079504 Pay System Price 2003 04715 2003 05 15 2003 05 01 2003705731 1002075504 Pay System Price 2003 04 30 2003 05 31 2003 06 01 2003706730 1002079504 Pay System Price 2003204228 2003 05 26 2003 01 201 2003701730 1002079504 Pay System Price 2003 04 01 2003704730 2003 01 701 2003701730 1002079504 Pay System Price C
43. on the case manager s affiliation with an agency After choosing the agency the Provider ID Name and Agency Phone will automatically fill TAB to Beneficiary ID field and enter the number that is listed on the beneficiary s medical card Tab Date of Birth Sex Last Name First Name Middle Init Living Arrangement Level of Care and SSN fields will automatically fill The eligibility fields will also automatically fill with the correct benefit plan s and effective dates This information comes from the SRS eligibility file For a description of Benefit Plans refer to Appendix B Revision Date 01 12 03 3 2 HCBS Plan of Care Prior Authorization Manual Note that the cursor is now in the Program field and click on the down arrow Select the assigned HCBS program TAB to Deinstitutionalized or Diverted and check the appropriate box Diverted is the default setting for this field Use Deinstitutionalized for beneficiaries who were in an institution immediately prior to entering waiver services This does not include planned brief stays Use Diverted for beneficiaries who are entering waiver services from the community TAB to Type of Review field and click on the down arrow Select appropriate type of review I Initial Annual R Revised TAB to the Reviewer field and using the down arrow select the ID of the reviewer to whom it will be routed Field Descriptions Case Manager Name Telephone Agency Provider
44. re Revision Date 01 12 03 4 12 HCBS Plan of Care Prior Authorization Manual Return to POC Search Screen Aan of Care eorecolt Imernet Explorer provided by EDS COE E E Edt Paecrten Tool Hik 12 33 esearch 9 l Se n 2 212 225 201 Provider 2 179 Links Links BEDS Infocertre Wadnasdag 3 55 Plan of Care Maintenance Pen ar Cans Cure Manger Anoy sy Bowen mw Beeeev o x 0 Dici ul ari ss Last Mame ma v Livi Arranegernert awaa Benef Plan Ered Tee arReview To return to Search Screen move the curser over the Plan of Care found in the banner at the top of the screen Two options are given Inquiry or Submit Choose one Revision Date 01 12 03 4 13 HCBS Plan of Care Prior Authorization Manual Section Five Approving an Existing Plan of Care Kansas MMIS Production System Logon MER KANSAS MMIS LOGON EB PRODUCTION Please Enter Tour User ID and Password _ Passwurd pu Approvers will use Kansas MMIS Production to Approve Plans of Ca
45. re Contact your IT staff if the KSMMIS Prod icon has not been added to your desktop The SRS security staff will assign a User ID and initial password to all Approvers Revision 01 12 03 5 1 HCBS Plan of Care Prior Authorization Manual Main Menu Production Main Memi PRODUCTION The Prior Authorization option will allow Approvers to view all Prior Authorization within the interChange Medicaid Management Information System Click on the Prior Authorization button Revision Date 01 12 03 5 2 HCBS Plan of Care Prior Authorization Manual PA Menu PA Menu The Prior Authorization and Table Maintenance buttons are for use by the fiscal agent Approvers will use the PA History option to view Plans of Care All screens will stack upon one another screens cannot be minimized Revision Date 01 12 03 5 3 HCBS Plan of Care Prior Authorization Manual Prior Authorization History Print Xuthurkratken Est ur Punider Lotar _ Barice Provider a Agency Cunt ome Foor Dieta Thra Dela From Thr B d Once the Prior History window appears a variety of options may be used in searching for Plans of Care To find a specific consumer Approvers will enter the Bene ID tab to the Assignme
46. required no changes Revision Date 01 12 03 4 9 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance Changes Continued When adding line items above the User highlighted the line item B and clicked the Add button to the right The box below emptied allowing the User to enter the new line item Line item D was then highlighted the Add button clicked and the next new line item was added It is not necessary to click Add after the item has been added only before If a line has been entered incorrectly it may be deleted only if there are no paid claims Users will highlight the line item to be deleted and use the Remove button to the right of the field A warning will appear to caution users to make sure they are not deleting a line that is associated with a paid claim Using this option will then allow the case manager to enter the line correctly When changing the Plan or adding new line items always click on the Submit button to save changes This automatically updates the plan to be approved Do not repeatedly click on Submit until you receive either a Successfully Saved or Unsuccessfully Saved message In some cases doing so has created extra If an error has been made while entering the Plan of Care Users will receive an Unsuccessfully Saved message The error must be corrected before continuing See Appendix C for Transaction Error List or call the HCBS Help Desk for more information
47. rior Authorization Manual Plan of Care Maintenance Continued Field Descriptions Indicators This field represents any questions specific to the selected waiver Status This field indicates the current status of the Plan of Care Monthly Cost This field auto fills with the total monthly cost of the plan Line ltems Total Client Obligation This field auto fills with the beneficiary s client obligation amount from the beneficiary s SRS eligibility file d 3 Jt bm mm 4 m ii EL Lee le ee Jem gie ic iL rad ann mn r F E FU To continue moving down the Plan use the scroll bar on the right hand side of the window and move to the Line Items section The top box in the Line Items section acts as a summary of services as they are added to the Plan Use the lower box to enter all authorized services Click Procedure field and type the HCBS procedure code Note as you type the information appears in the Line Items field above Tab through the Modifier fields and enter modifiers if appropriate Revision Date 01 12 03 3 6 HCBS Plan of Care Prior Authorization Manual Plan of Care Maintenance Continued TAB to Requested Effective Date field and type service start date in mm dd yyyy forma
48. t Note the down arrow next to this field Clicking on the down arrow will bring up a calendar for the current month which allows the option of clicking on a date which will automatically fill the effective date field TAB to End Date field and repeat above procedure MRDD Users will enter the last day of the beneficiary s birth month SED Users will use a one year anniversary date all other Waivers will use the end date of 12 31 2299 HOW TO ENTER UNITS DOLLARS Users will enter Units when MMIS is set to allow a specific amount for one unit of service Units will be used for all HCBS services except those noted below Dollars will be used when the amount allowed 15 calculated by a negotiated rate Use Dollars when the procedure code is based on a dollar amount allowed on the rather than units e MRDD Home Modification MRDD Vehicle Modification MRDD Specialized Supplies not otherwise specified MRDD Specialized Medical Equipment PD Personal Services PD Assistive Technology HI Personal Services HI Assistive Technology Both Units and Dollars should be used when amount is calculated by tier level e MRDD Habilitation Residential e MRDD Day Habilitation e MRDD Attendant Care In this case enter the monthly unit total in the Units field enter the unit price tier level rate in the Dollars field TAB to Units When appropriate enter the amount of units being requested for this procedure code for a one month time period
49. t Text Hon zensusPfur Appeals Emergence Guppi e Lm mayn Remark Super The Prior Authorization window identifies basic information about the Plan of Care The Case Management agency 1s identified along with the consumer s name and Bene ID The PA number the waiver the Clerk ID and the date the POC was entered can also be found on this screen A check mark in the Internal Text field indicates there are notes attached to this Plan of Care The other options in this box are for use by the fiscal agent As Users enter or make changes to the Plans of Care on the web they are required to enter documentation in the Notes field of the Plan The Approver can view these notes by double clicking on the words Internal Text Revision Date 01 12 03 Do HCBS Plan of Care Prior Authorization Manual Prior Authorization Internal Text T prem daturi inl Tost eth pen 1 Ann tome HF nre duplicaten but deem O n dieni amoun Client Core chy UBT IRE AEs Amaal pdala Tint change 8 02 2 ET This information will aid Approvers in determining the appropriateness of the Plan and will provide calculations to help explain the total cost Notes will appear in chronological order with the most recent note first Use the scroll bar on the right side
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