Western Highlands Provider Friday Newsletter, 10/05/07

	Western Highlands Network
	Friday E-Mail Newsletter Number 101 10/05/2007 The Friday E-Mail is a weekly update for providers by the Services Management Department of Western Highlands Network. Please distribute to all your staff. Some tips about the SAR! We hope you have had an opportunity to review the last Friday Email, and the links to new grids, new SAR and new Description of Consumer’ Clinical issues. We are trying to make these documents and benefits as easy to understand as possible, and give you many opportunities to be more efficient in making submissions to Western Highlands. The Division of Mental Health (DMH) and The Division of Medical Assistance (DMA) have just published the Complete PCP with the Diagnosis Section now included. You will also note there is also a Diagnosis Section of the newest SAR. *Please remember that you only have to complete the Diagnosis Section on the SAR if you add or change a diagnosis.* When you include updates to this section, our staff will update this information in the consumer’s profile in the Western Highlands system. YOU DO NOT NEED TO CONVERT CURRENT, COMPLETE PCPs TO THIS FORMAT FOR IPRS CONSUMERS (see Friday Email #100 for explanation of the types of PCPs). The new SAR (dated 10/3/07) on the website gives you an opportunity to include diagnoses when you make requests. Take a few moments to get familiar with the newest version of the SAR. We have published this document as a Word Document (at the following link under Service Authorization Requests) http://www.westernhighlands.org/pr_servauthprocedures.htm , so you can print it, and complete it by hand, or you can tab through the fields, type and print the document so it is very clear and legible. Many providers develop Word Files with basic information included for each of their consumers (i.e. name, consumer number, name of requesting staff, fax and phone number, etc.) so that the process is not duplicative each time you need to submit a SAR. In addition, we are trying to make the “paper SAR” similar to the future electronic SAR. Something we've noticed... When the Introductory PCP was initiated on 7/15/07, many providers began to use that document, and have the medical necessity signature dated for the time period for which the Introductory PCP was valid. Within 30 days they updated to the Complete PCP format using their initial medical necessity signature. This is not a problem... now. Please check the dates of your Complete PCPs and the medical necessity signatures. We have noticed up to a 30 day gap is possible from the review dates noted on the Complete PCP, and the lapse of the medical necessity signature. Please review your plans to make sure you are covered for all the services you provide. NEW PHONE NUMBERS PLEASE NOTE - All future calls to WHN by Providers should be to 1-800-671-6560. Please do not use 225-2800 as this is no longer the # for providers. If you are a provider calling Western Highlands from Buncombe County, use the local phone number 225-2785. BASIC BENEFIT Many consumers seeking care through the mental health system only need to be seen a few times by a licensed clinician, or by a provisionally licensed clinician. Statewide, the average stay in outpatient treatment was less than 3 sessions. Over Western Highlands’ history, the average length of stay in outpatient therapy is just over 4 sessions. We introduced an 8 event/32 unit benefit back in the spring, and want to encourage providers to consider the use of this benefit. In routine care cases, it may prove to be the service that most directly impacts the consumer’s issues. In cases where the provider is unclear about whether the consumer qualifies for enhanced benefits, you are able to attempt a lower level of care, providing you with more time to assess appropriateness for enhanced benefits. Not every consumer entering care needs Community Support and many can be effectively served in outpatient care rather than in Enhanced Benefit services. Use of the Basic Benefit only requires the 4 page PCP. A Final Note Agencies who are Case Responsible Entities (CREs), and who serve as Clinical Homes to consumers are responsible for providing consumers in their care with After Hours and Emergency Service coverage via First Responder. If a case is open to your agency, you need to assure that you have access to crisis plans, and the staff from your agency responding to consumers in crisis should be able to access these plans as well. It is not appropriate to refer consumers to 911 or to Emergency Rooms by instruction or via messages on phone answering systems, and in the event of an emergency, the on call staff for your agency should intervene. There are rare exceptions to this rule, and these cases must be reviewed with Western Highlands on call staff after the CRE first responder has attempted to manage the crisis (including face to face contact, consideration of use of Mobile Crisis, etc.). We are excited about what the future holds for a crisis continuum in our area and the improvements we can make together in consumer care. Western Highlands Network 356 Biltmore Avenue Asheville, NC 28801 Providers Call: 828-225-2785 or 1-800-671-6560 Fax: (828) 225-2779 E-Mail: ring@westernhighlands.org Website: www.westernhighlands.org