Western Highlands Network
Friday E-Mail Newsletter
Number 62
07/28/2006
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.
A Few Words About Service Authorization Requests, Progress
Towards Goals,
Value Options and Incident Reporting...
For WHN to accurately process Service Authorization Requests (SARS) in an accurate and timely manner, it is incumbent on the treating Qualified or Associate Professional to include a clinical statement of progress towards goals in the labeled section of the SAR.
WHN staff must have this information to determine continued medical necessity for services. This statement should address specific goals and give measurable information on progress towards the specific goal.
Please be advised that as stated in Communication Bulletin # 24, on 3/2/06, incomplete SARS will be rejected. This includes SARs that do not address progress towards goals.
If your SAR is rejected for this reason, you must re-submit the revised SAR.
If your SAR is pended by a reviewer for additional clarification, please fax the additional required information either on your Letter of Notification or on an additional sheet of paper, under the fax cover sheet.
This information should include the needed information as well as the date and the signature of the clinical staff providing the information.
Please be advised that sending clinical information on the fax cover sheet is a HIPPA violation, and fax cover sheets are routinely shredded.
And now a Review of Incident Reporting Requirements...
One of the most stress inducing aspects of providing quality clinical service can be knowing what to do when a critical incident occurs. One way to help mitigate this stress is having a thorough knowledge of the mandated NC Division of MH/DD/SAS reporting process.
Here are a few quick reminders:
- For Level II and III incidents use DHHS Incident & Death Report
Form QM02 Effective october, 2004 - Rev. 3/8/06 (See pages 5 & 6 to determine
level for the incident.)
DHHS Restrictive Intervention Details Report Form QM04 Effective October 2004 Rev. 11/18/04
When reporting restrictive interventions, submit BOTH forms.
- For Level I Quarterly Reports use Provider Quarterly Incidents Report
Form QM11 (Revised January 2006)
WHN should receive a quarterly report from ALL providers. If you had no Level I incidents then indicate 0. Notice there is an accounting of the number of Level II and III incidents reported and a place to note if any incidents occurred which were not reported.
You may email the Level I Quarterly Reports because they do not have any consumer-specific information on them. Email to lynn@westernhighlands.org or fax to 828 225-2784.
- Forms must be submitted within required timeframes as noted in the instructions.
- Forms must be legible and ALL ITEMS COMPLETE. Do not need to send pages 4-6
- Make sure you are using LME record number and not Social Security # on forms.
- Fax to 828 225-2784 attn: Lynn Trotter (This is a secure fax machine.)
Please visit our website (www.westernhighlands.org then click on "For Providers" then on "Incident Reporting Forms and Documents".) This connects you to the most recent forms on the Division website and lists where to send the forms, etc.
Thanks for your attention to this issue!
AND Finally...
Help us to serve you better!!!
The WHN provider survey is open until 8/14/06.
Please take a moment and complete a WHN provider survey. The survey is open until 8/14/06 and is applicable to ANYONE that works for a provider, regardless of the role.
To find the survey please go to http://www.zoomerang.com/survey.zgi?p=WEB225GMEK9VNG
Charlie Schoenheit
Director of Services Management
Western Highlands Network
356 Biltmore Avenue
Asheville, NC 28801
Telephone: (828)258-3511 x2219
FAX: (828) 225-2779
E-Mail: Charlie@westernhighlands.org
Website: westernhighlands.org
