Rate increases for the previously designated ADvantage services will be in effect on November 1, 2012, and all systems should reflect the increases on this date (Refer to the AAU Provider Update Sent September 27, 2012 for a review of affected services).
Please refer to this communication as a guide and immediately disseminate this information to staff as deemed appropriate. The following processes will be temporarily applied in order to implement the rate change and to ensure timely and accurate billing post conversion:
- 6Gs: Due to the magnitude of this conversion, Member specific 6g’s will not be distributed. Each agency will receive a comprehensive report detailing all services lines affected for each Member served.
- T1016 Case Management: Regarding the Case Management service line (T1016): The service plan, before the conversion, will end a service line and begin a new service line. A maximum of 25 units of T1016 will remain on the ending service line with a date ending 10/31/2012. The remaining T1016 units will be transferred to the service line beginning 11/01/2012 at the increased rate. For example; if a plan has 75 units remaining, this same plan after conversion will have 25 units assigned to the line ending on 10/31/2012, the remaining 50 units will be allotted to the new service line beginning 11/01/12. Conversely, if a plan has a balance of 25 or fewer units remaining, the balance on the line beginning 11/01/2012 will reflect zero units available.
- December 31, 2012 submission: In order to proactively address issues related to the conversion, Providers are advised to submit addendums requesting amendment to the Service Plan as a result of this conversion no later than December 31, 2012. One example of a Service Plan that would be affected would be a Service Plan with a zero balance of T1016 after the conversion is completed.
- New Case Service Plan Development: Be advised that all Case Managers receiving authorization of 40 units of T1016 for new service plan development, the 40 units received will be placed on the old Prior Authorization line ending 10/31/2012. The new Prior Authorization will be opened in the system with a date of 11/01/2012 and will reflect zero units until the completed Service Plan is received. For those plans with the initial 40 units of Case Management authorized, and have not completed the initial IDT, please contact the AAU, as we will make the change manually following the conversion.
AAU has taken great care in making the rate conversion as seamless as possible, but any change, especially one this substantial, may result in some anomalies. We are likewise postured to address these instances and ask that providers contact us through the Provider Questions email. Please be aware that any issues we find are likely to be uncommon and we will transmit any necessary mass email updates immediately upon discovery. Thank you in advance for your support as we implement this positive change.
If you have any questions or concerns regarding the information provided above, please feel free to contact us via email at Provider Questions.