July 27, 2011
As mentioned in the AAU Update sent on May 17th, we are in the process of converting all of the ADvantage Program forms to meet the OKDHS guidelines for ADA compliance. The form used to request Nutritional Supplements, ADv6a1b – Orally Administered Nutritional Supplement Documentation of Need has also been revised and updated. It is to be replaced by the 02CB037E – Request for Nutritional Supplements. One of the purposes in revising the form is to have all of the information required for authorizing Nutritional Supplements on one form. Complete information on the form should reduce the need for multiple communications between AAU and the Case Manager concerning the request.
This form, 02CB037E – Request for Nutritional Supplements, and instructions for its use can be accessed on the OKDHS Library. Once on the website, you will see the forms listed as in the example below. Click on the blue circle with the question mark inside to open instructions.
Form 02CB037E, Request for Nutritional Supplements, documents the member's nutritional status to meet authorization guidelines and verifies that all required documentation is attached. Authorization for payment of oral nutritional supplement products requires documentation of medical necessity by the case manager. The Physician’s prescription ordering nutritional supplements must also accompany this completed form. The form must be completed and signed by the member and the case manager. The case manager must document the medical need for which oral nutritional supplement is an accepted treatment, nutritional outcome, action steps, and monitoring plan.
In addition to the fact that this form is easier to read and use there are a couple of other enhancements:
- There is a section to mark the type of request (oral or enteral, new or change) as well as a section to provide the nutritional supplement prescription information including product name, amount and frequency, and related diagnosis for which it is being prescribed.
- There is also a height and weight information section that actually allows for the entry of pertinent information to document height, weight, body mass index, and documentation of whether the Member has experienced an unintentional weight gain or loss of 10% or more. The instructions document for this form accessed by clicking on the icon will be of particular use with completing this section.
- There is also a section for providing description of any existing wounds the Member has for which they may need the requested nutritional supplements.
Please note at this time there is not an official implementation date however, agencies are encouraged to become familiar with the new form and may begin using it now.
If you have any questions or concerns regarding the information provided above, please feel free to contact us via email at Provider Questions.