(spw) sas help file

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United Healthcare Nueces 1014437 United Healthcare Travis 1014438 Amerigroup Bexar 1014439 Amerigroup Harris 1014440 Amerigroup Jefferson 1019599 Amerigroup Travis 1014442 Amerigroup El Paso 1019979 Amerigroup Lubbock 1019983 Amerigroup Tarrant 1018977 Bravo Health Tarrant 1018979 HealthSpring (Bravo) 13. Leave NPI at the default. 14. Save the record. 15. Submit the record. Hidalgo 1019984 Money Follows the Person Authorization for an SPW Applicant SAS Help File After SPSU verifies that the consumer left the nursing facility, they complete the following steps listed below. SPSU does not close the Authorizing Agent, Medical Necessity, Level of Service (RUG) records. SPSU must also insure Provider Claims Services closes the Enrollment and Service Authorization records for Service Codes 1 or 3, 60, and 50. Create a one day STAR+PLUS service authorization for the first day of the month in which a MFP consumer is discharged from a nursing facility and begins receiving Home and Community Based Services STAR+PLUS Waiver (SPW) services, unless the MFP applicant discharges on the first of a month. For example: a consumer leaves the nursing facility and begins (SPW) services on 12-25-11. The SPSU staff registers the initial ISP in SAS with an effective date of 12-25-11 through 12-31-12. In addition to registering the initial ISP, the SPSU staff creates all the records listed below with a Begin Date of 12-01-11 and an End Date of 12-01-11. Revised: 4/23/2012 27
SAS Help File Add the following records for Service Group 19 to create the one day service authorization: Service Authorization Medical Necessity Diagnosis Level of Service Authorizing Agent (if needed) Enrollment Service Plan A one day overlap of the records listed is allowed. Note: Members released from a nursing facility and authorized for SPW services should be enrolled under Money Follows the Person. In the Enrollment record, select “Rider 28/37 FAC to COMM” from the drop down list in the Enrolled From field. Do not use “Enrolled from nursing facility” to designate MFP members. To Authorize SPW Eligibility for an MFP Applicant: After creating the one-day records above, create the records needed for the ongoing MFP SPW eligibility. These records must be completed to create an initial service authorization for SPW: Authorizing Agent Enrollment Service Plan Service Authorization Level of Service Medical Necessity Diagnosis Authorizing Agent - SPW There will be one authorizing agent registered for an MFP applicant. The STAR+PLUS support unit (SPSU) or Health and Human Services Commission Managed Care Operations (HMCO) staff is registered as the authorizing agent when the initial authorization is authorized. To register an authorizing agent for an MFP applicant: 1. Select Authorizing Agent in the Case Worker directory. Revised: 4/23/2012 28
Page 1: STAR+PLUS WAIVER (SPW) SAS HELP FIL
Page 4 and 5: Initial Service Authorization / SPW
Page 6 and 7: Enrollment - SPW To register enroll
Page 8 and 9: 8. Move to the Units field and ente
Page 10 and 11: 14. Save the record. 15. Select Sub
Page 12 and 13: 2. Select Add and a blank Medical N
Page 14 and 15: 8. Save the record. Reassessment Se
Page 16 and 17: 1. Select Service Authorization in
Page 18 and 19: 4. Move to the Service Code field a
Page 20 and 21: To register a Service Authorization
Page 22 and 23: SAS Help File 3. Move to the Servic
Page 24 and 25: Transfers / SPW SAS Help File There
Page 26 and 27: 5. Move to the Termination Code fie
Page 28 and 29: SAS Help File outlined in Initial S
Page 32 and 33: 2. Select Add and a blank Authorizi
Page 34 and 35: Enrollment - SPW To register enroll
Page 36 and 37: 10. Move to the Begin Date field an
Page 38 and 39: Level of Service - SPW SAS Help Fil
Page 40 and 41: 3. Move to the MN field and select
Page 42 and 43: United Healthcare Jefferson 1019600
Page 44: 1. Search for the member’s SPW ca

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