(spw) sas help file

Level of Service - SPW
SAS Help File
There will be an existing Service Group 1 (NF) Level of Service record.
However, the SPSU will be required to create a new Level of Service record for
Service Group 19 SPW. The Service Group 1 (NF) Level of Service record can
remain open.
To add a Level of Service record, complete the following steps:
1. Select Level of Service in the Medical directory.
2. Select Add and a blank Level of Service record will appear.
3. Move to the Type field and select CR – CBA RUG from the drop down
list.
4. Move to the Service Group field and select 19-STAR+PLUS from the
drop down list.
5. Move to the Level field and enter the Rug group.
6. Move to the Begin Date field and enter the first day of the ISP period.
7. Move to the End Date field and enter the last day of the ISP period
8. Save the record.
Medical Necessity - SPW
The MCO nurse completes the Medical Necessity/Level of Care Assessment
(MN/LOC) and submits the information to TMHP. After Medical Necessity is
determined and the RUG value is computed, TMHP submits the decision back
to DADS where it is stored in the SAS database.
This record is system generated from the information stored in the SAS
database. This system-generated record will have an End Date that must be
extended through the last day of the month in which the Medical Necessity
determination expires.
For example, if Medical Necessity is approved with an effective date of 5-13-
11, the system-generated end date will be 5-12-12. If the ISP period is 6-01-11
to 5-31-12, the Medical Necessity record will need to be extended to 5-31-12
so the member has coverage for the entire ISP period.
To extend a Medical Necessity record for an MFP applicant:
1. Select Medical Necessity in the Medical directory.
Revised: 4/23/2012 35