Western Highlands Provider Friday Newsletter, 2/16/07

	Western Highlands Network
	Friday E-Mail Newsletter Number 87 2/16/2007 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. Work Smarter Not Harder! Here are the Answers to some Frequently Asked Questions Thanks to everyone who participated in the provider survey last fall. One of the suggestions we received is to have a mechanism to address frequently asked questions. Here is the first installment. All of the Q and A's will eventually be posted on the WHN website. What do I do when I have a SAR pended? When you respond to a pended SAR, fax your response/corrections. Review the information carefully so you can respond to all of the concerns for which your SAR was pended. Do not use e-mail or Provider Link. Include with your fax a copy of the LON which you received notifying you of the pend. Please remember, you must respond within 14 days or you will need to submit a new SAR with current dates. When do I send in the signature page on the PCP? The signature page should be sent when the plan is originally completed, when a new service is added (must be dated when the new service is added), and when the annual review is done (must be dated when the annual review is done). How can I make sure my faxes go through? Remember to put the consumer number and the number of pages on the fax cover sheet. Also, check your confirmation notice to make sure that it was sent. Please send all associated documents for the same consumer at the same time. What can I do so my SARS are not rejected when they are sent? The most important thing to remember is to fill out the SAR completely. Incomplete SARs cannot be processed and will be rejected. If your SAR is rejected, please do not send in the LON. Rather, complete a new SAR. How can I get medical records for consumers that were receiving services from New Vistas Mountain Laurel? New Vistas-Mountain Laurel records will continue to be available at no cost to the providers and consumers through March 15, 2007. New Vistas-Mountain Laurel has arranged to provide management of the process of copying, storing and retrieving client records from January 1, 2007 - March 31, 2007. Call 828-233-2522. Leave a message with your name and number and at least the full consumer name and date of birth for the record you are requesting. They will call you back. You will still be able to retrieve New Vistas-Mountain Laurel records after March 15, 2007, but it will take longer and there may be a cost. More detailed instructions will be sent as available. What can I do to make sure I get my Letters of Notification? If you are not getting your Letters of Notification on a timely basis, there are a couple of things to check. Check the email address that you are using on your SAR. Is it 32 characters or less? Check with your office manager to see if he/she received a copy of the LON. Check if your online service recently installed updates. After some services (AOL and Hotmail) are updated, the LON can be blocked as spam. As employees leave, make sure that their email addresses are deleted and new staff are added as soon as possible. If you have submitted a SAR and have not received an LON within 5 days and you have done all of the above, then call Kim Kuhn at 225-2800 or Candace Rice for assistance. How can I find out if my consumer has Medicaid? There is an excellent resource on the Division of Medical Assistance Website, wherein providers can learn how to assess Medicaid status. This will help you learn more about the multiple and most expedient methods of verifying eligibility status. In addition, the website assists providers with figuring out the Medicaid plan the consumer is covered by using card colors and codes. This will assist you in determining whether mental health services are covered by the Medicaid card carried by the consumer. The site is www.dhhs.state.nc.us/dma/bulletin/BasicMed1006.pdf. This resource has a lot of valuable information for providers. Western Highlands Network highly recommends that all providers share this with their employees. To access the automated voice response system, call 1-(800) 723-4337. How do I track SARs to ensure that all my consumers have timely authorizations? If you have found a method that works for you, stop reading. (If it ain't broke, don't fix it!) But if you are still struggling with how to track all your service authorization requests; we suggest that you use a simple tracking sheet. If you prefer computers, an Excel spreadsheet will do the trick, but it's probably easier to simply use a manual form. We've posted a "Services Authorization Tracking Sheet" on the WHN website: http://www.westernhighlands.org/pr_servauthprocedures.htm. Print it out. Complete it in pencil, because the information will change. There is room for 10 consumers to a page. The space for each consumer is large enough to allow you to write in several services. Put the sheets in a notebook. How to Use the Tracking Sheet First, you must make sure that you receive all Letters of Notification (LONs) when you submit a SAR. The SAR has a space for your e-mail address. If your agency has the LON sent to another e-mail address, you also should get a copy. When you receive an LON, enter it on the tracking form. Use pencil so you can change the dates when you receive continuing authorizations. Check the LON for status (approved, pended, or rejected), the service, and the effective and lapse date. Enter the IPRS expiration date. This will remind you when it is time to do a new IPRS form. We'll only authorize services up to the IPRS expiration. Check the funding source each month, because for some consumers, this changes frequently and will affect your SAR. For example, if the consumer gets Medicaid, you will need to send your request to Value Options. When you submit a new SAR, the start-date should be the day after the end-date from the previous authorization. Keep the tracking log on your desk. Check it when you talk to a consumer. Also, "eyeball" it regularly to make sure everything is up-to-date. Pay special attention to the "pend" column. If you have an authorization problem, call the LME. And now a quick word about Timely-Filing-Limits Based on historic State timely-filing-limits, generally dates of service July through April were subject to a mid- June filing deadline, and dates of service May through June were subject to a mid-August filing deadline. Although the State end of fiscal year 2007 timely filing limit has not been announced, Western Highlands offers this information as a "heads up" about end of year timely filing limits. Upon notification from the State, Western Highlands will publish specific State FY07 timely filing limits. 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