What is OK AuthentiCare?

OK AuthentiCare is an electronic scheduling, tracking, reporting and billing system for in-home care providers. This paperless, Web-based system also provides real-time access to information needed for member services management. Claims are generated automatically by phone calls to the OK AuthentiCare toll-free phone number from the member’s home. OK AuthentiCare verifies that the worker is present in the member’s home, records the service performed and compares it to services authorized. A claim is generated when a valid check-in and check-out are completed. When the claim is confirmed by the provider using the Web, it is sent to the Oklahoma Health Care Authority (OHCA) for adjudication. OK AuthentiCare also generates standard reports that are available to each provider.

How does OK AuthentiCare work? OK AuthentiCare is based on simple principles:

1. The worker goes to the home of the member to provide a service that has been prior authorized.
2. The worker uses the participant’s touch-tone phone to call the toll-free OK AuthentiCare number.
3. Using caller ID technology, OK AuthentiCare identifies the member and the services prior authorized for that member. The Interactive Voice Response (IVR) system prompts the worker to enter his Worker ID number and verify the service he is there to provide.
4. The system verifies that the worker is appropriate to provide the prior authorized service for the member and advises the worker that he/she is “checked in”.
5. When the worker completes the service, the worker calls the same toll-free number and “checks out”.
6. From that telephone interaction, OK AuthentiCare generates a claim. After the provider reviews and approves it, the claim is submitted to OHCA electronically for payment.
7. Claims are submitted for processing daily. Payment for the service is made directly to the provider from OHCA.
8. The electronic remittance advice from OHCA is uploaded into OK AuthentiCare, matching each claim submitted to the adjudication made.

In situations where the IVR system cannot be used (the phone is out of order) or situations where the worker makes an error (forgets to call out before leaving the home); the worker notifies his/her supervisor and provides the needed information about the visit. The provider enters the visit information into OK AuthentiCare via the Web, thus creating a claim for the service provided. For case management services that do not require a visit to the home, the provider must enter the required information via the Web to create a claim.

 

What Information will be available via the Web?

Providers can access standard reports via the Web through OK AuthentiCare anytime free of charge. They are on-line, real time (current) and provide detailed information including:

• Status of services in progress
• Late and missed visit notifications
• Claims ready for confirmation by the provider as well as claims submitted to OHCA by OK AuthentiCare for the provider
• The status of service activity that has not been submitted to OHCA (with exception codes to indicate why the claim has not been submitted)
• Authorized units of service by participant
• Service events scheduled for a participant
• Remittance advice

Do all home care provider agencies have to use OK AuthentiCare?

All who provide Personal Care, Nursing, Advanced Supportive/Restorative Assistance, In-Home Respite, CD-PASS Personal Services Assistance, Advanced Personal Services Assistance and Case Management for members enrolled in the ADvantage Waiver and the State Plan Personal Care program.

Do I have to pay to use OK AuthentiCare?

No, OK AuthentiCare is a free service for providers and members.
When is OK AuthentiCare available? Both the IVR and the Web site are available 24-hours a day, seven days a week.
Will OK AuthentiCare work from any telephone? It must be from a touch-tone phone.

What if there is no touch-tone phone?

Contact a supervisor as soon as feasible for instructions.

What if there is no phone at all or the participant refuses to let the worker use it?

Contact a supervisor as soon as feasible for instructions.

What information should a worker have available when calling OK AuthentiCare?

1. The OK AuthentiCare toll-free phone number
2. His/her worker ID number
3. The participant’s Medicaid number
4. The phone number of a supervisor in case there is a problem
5. The list of activity codes

What is the worker ID number?

Workers will be enrolled in OK AuthentiCare and the worker ID number generated by the system must be given to the worker. If a worker works for more than one provider agency or more than one branch office of the same provider agency, he/she will have a separate worker ID number for each agency and each branch office. A worker cannot use OK AuthentiCare without a valid worker ID number.

How is a worker to remember several ID numbers?

OK AuthentiCare will provide a key fob for each worker. On the front is the toll-free OK AuthentiCare number and on the back is room for the worker to write one or more ID numbers.

What if I forget the Worker ID number?

Call the provider agency where the worker ID number is maintained on file.

What if I make a mistake using OK AuthentiCare?

• If the mistake is made while still on the call, you will have an opportunity to correct the information before completing the call.
• If the mistake is made after completing the check-in call but before checking out, you will have an opportunity to correct the information during the check-out call.
• If you realize the mistake after completing both the check-in and check-out calls or fail to make one or both of the calls, you must contact a supervisor. Your agency’s staff has the ability to correct your mistake using the Web site.

Why would I want to go to the OK AuthentiCare Web site?

• To schedule a worker’s visit to the member’s home
• To track whether the worker arrived as scheduled
• To confirm claims prior to OK AuthentiCare submitting them to OHCA for payment
• To maintain information (add, modify) on workers
• To maintain information on State Plan Personnel Care members
• To verify payment for services rendered
• To generate one of the many standard reports containing real time (current) information on service activity for workers and members.
• To access the links to OK AuthentiCare training materials

Who can see a provider’s information on the OK AuthentiCare Web site?

• Providers can see information about any activity associated with their OK AuthentiCare branch ID.
• Case Managers can see information about any activity for the members in their caseload.
• A provider branch cannot see the information of another provider branch.
• OKDHS staff and Help Desk staff can see all information in OK AuthentiCare.

If I don’t have access to the Internet, will OK AuthentiCare or OKDHS send me reports on a scheduled basis?

No. Reports are only available on the Web site.

Do I need special equipment or software to access and use OK AuthentiCare?

A computer with Internet access is required – a high speed (broadband) connection will provide best performance. No special software is required.

Where do I get training to use OK AuthentiCare?

• Agency staff will be trained prior to implementing the system. Each agency will be responsible for training their workers.
• A Train-the-Trainer Kit is provided as well as a Training IVR and a Training Web site. These are designed to help agencies train new workers to use the IVR and new agency staff to use the Web site.
• The most current training materials will be maintained on the OK AuthentiCare Web site.

What must I do as a provider?

• Enroll your workers in OK AuthentiCare and maintain accurate information for each worker.
• Give each worker the ID created for them by OK AuthentiCare and train them to use the IVR system.
• Ensure that workers use the member’s telephone to call OK AuthentiCare when they provide services.
• Add State Plan Personal Care (SPPC) clients and authorizations in OK AuthentiCare and maintain accurate information for each SPPC client.
• Use OK AuthentiCare to schedule worker visits.
• Respond to e-mail alerts that notify you when a worker is late or missed a scheduled visit.
• Add and/or correct claims on the Web site as needed.
• Approve claims in OK AuthentiCare so they can be submitted to OHCA.
• Review your Remittance Advice in OK AuthentiCare after each payment cycle. As needed, work denied or pending claims using OHCA’s Web site as you do now.

For questions regarding OK AuthentiCare, e-mail Provider Questions