Oct. 8, 2010
Effective Wednesday, Oct. 13, new ADvantage member cases will receive prior authorizations for the initial 40 units of case management and 5 units of RN Evaluation services for development of the member's service plan.
How will the new process work?
Step #1: Provider Agency Receipt of a New ADvantage case
- Agencies will receive a faxed 6g (in place of an ADv4).
- The 6g will be faxed to both the Case Management and the Home Care agencies.
- The 6g will state that services are “conditionally authorized pending receipt of a service plan.”
- The remainder of the new case packet will follow, via postal service, as it always has.
Step #2: Confirming Prior Authorization
- Prior authorization numbers for the two initial services will be posted on OK AuthentiCare within two business days following the creation of the 6g.
- 6g faxed to CM and HC providers
- Monday night PA# is sent to OHCA
- PA# confirmed by AAU and sent to OK AuthentiCare
- PA# appears on OK AuthentiCare
Step #3: Assigning a Case Manager
The Case Management agency may choose to disregard the name of the individual case manager listed on the 6g and reassign the member case to a different individual case manager using the OK AuthentiCare administrator role.
Step #4: Submitting a Member Service Plan
Case Managers should submit the service plan packet per standard procedure. Upon authorization the AAU will simply extend the initial prior authorization units from the original unit amount to the total number of units required for the service plan year per the information submitted by the Case Manager.
For RN Evaluation services the prior authorization will be extended to include the six-month monitoring and annual reassessment visits.
Step #5: Conditions
The conditions section of the service plan should be reviewed for any important information you will need to know about the case, i.e. member in the NF to home (transitional services), member in assisted living, SPPC transition case, priority, etc.
Institution Transition Services - Please follow the existing process for requesting Institution Transition services units. Regular Case Management units may not be applied because the services cannot be authorized until the person transitions out of the Nursing Facility and has a begin date the same as NF discharge date.
- Agencies are able to use the prior authorization listed on OK AuthentiCare to submit claims for CM and RN Evaluation services provided prior to submission and full authorization of a service plan.
- New member information will be uploaded to OK AuthentiCare along with the initial prior authorizations.
Please direct questions regarding the implementation of OK AuthentiCare, to: AuthentiCare@okdhs.org