Western Highlands Network
Friday E-Mail Newsletter
Number 97
6/29/2007
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.
A Few Reminders about PCPs revisions and rules...
Hang in, the weekend is coming!
Until then, we wanted to provide you with a few pointers around errors we are seeing often on PCP revisions.
Prior to writing a new PCP, or revising one, review the current PCP. Please remember that you have to deal with any prior goals, even if you are writing a new PCP for the consumer. We have noticed a problem when the working or current PCP was developed by one Q and the case is later picked up by another Q. You will need to end, and explain any goals you discontinue. For example, if the consumer had difficulty sleeping in the PCP written in November of 2006 and increasing sleep was a goal, when you write a new PCP in June of 2007, you will need to make note of what happened with this goal. If the problem resolved, simply note this, and code "D" for Discontinued on the PCP. If the problem is ongoing, note this, and code "O" for Ongoing on the revision or new PCP. Also, remember not to use code "R" on the PCP for Review, this is reserved for Revision. Note that you only have to submit the revised pages when you are truly revising the PCP, and not the whole PCP.
In PCP development, signatures are needed when; 1) there is a new service, 2) when there is a new provider, 3) when there is a new diagnosis, 4) annually. Always make sure you are adequately covered in these situations and get new signatures. In the event you are only doing a revision on existing/ongoing goals and the same service array, a signature from the consumer attests that you have been actively involving the consumer in their care, and they have agreed to the revision.
A couple of final notes on PCP matters:
If you are requesting
standard care from the Standard Care Guidelines, and your request is
accompanied by (or we already have) all of the necessary paperwork, your
SAR will likely be reviewed and approved by Authorization Technicians.
Between 60% and 70% of the time, this is the case. These staff evaluate
for technical adequacy, and do not perform an in depth clinical review.
Occasionally, your request will be passed on to Clinical Specialists
for review. If you have a request for care outside of the Standard for
the consumer's condition, Clinical Specialists will review your
case. In this situation you may be asked for more information, or documents
you have previously submitted and had approved may be queried. This process
is not meant to be critical of you and your work, or harm you in any
way, but constitutes true Utilization Review.
Finally, to quickly differentiate what goes to Access and what goes to the Services Management Unit, use these simple rules:
If you do not yet have a PCP, information needs to go to Access.
If you have a PCP, information needs to go to Services Management.
The Access fax number is: 828-225-2782
The Services Management Unit fax number is: 828-225-2779
The following attachments might serve as reminders, and can be posted by your agency fax machines.
http://www.westernhighlands.org/SARP/Access_Fax_Number_Posting.doc
http://www.westernhighlands.org/SARP/Services_Mgt_Fax_Number_Posting.doc
Lost in the mail LONs?
We have had reports from providers that they are not getting feedback from Western Highlands about the status of requests, both in Access and in Services Management. To enhance your chances of getting quick feedback, please check out the following points:
- Make sure you put your correct email address on STRs and SARs.
- Make sure your server is not placing LONs in SPAM folders. This seems to be a common problem when security systems are updated.
- Be careful with staff turnover and new staff training. Inaccuracies in who receives the LON may cause the "lost" LON to be sent to someone who has resigned, or a new staff member who has not been added to your agency's email address.
- When you are expecting an LON, check first with your provider's standard mailboxes )listed on the bottom of each LON) to see if it is accounted for in one of those mailboxes.
SFY08 Purchase for Service Contracts
State Fiscal Year 2008 Purchase for Service contracts will be distributed via e-mail rather than through the mail this year. We anticipated release mid-June with the expectation your agency will return them by July. Claims payment is contingent upon a fully complete and executed contract. The state standardized contract was revised to include content and format changes. If you do not receive a contract by mid-June please contact the Business Office at (828) 225-2800 ext. 2185.
Coming Soon: Western Highlands Website Survey
WHN is in the process of developing a survey for our providers, consumers, and community stakeholders. The purpose of this survey is to obtain feedback from our various users on the current format, structure and content of our website. You can expect this survey to be posted on our homepage next week. We look forward to receiving your feedback and suggestions as we prepare to remodel our existing site.
Thanks for the commitment and care you provide to our consumers.
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
