(spw) sas help file

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United Healthcare Jefferson 1019600 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) 14. Leave NPI at the default. 15. Save the record. Hidalgo 1019984 SAS Help File Note: Once the 365-day timeframe for MFPD has been used, the fund code in the Service Authorization record will be changed to the default. Money Follows the Person Eligibility for an Applicant Moving to CBA After the SPSU determines eligibility for SPW and notifies the applicant of waiver eligibility, the consumer will discharge to the CBA region. The SPSU will not enter any records in SAS. The gaining CBA case manager will complete the CBA authorization in SAS using the CBA Wizard. Money Follows the Person Eligibility for an Applicant Moving from CBA to SPW After the losing CBA case manager determines eligibility for CBA and notifies the applicant of waiver eligibility, the consumer will discharge to the managed care service area. The SPSU will enter SPW authorization into SAS after the applicant moves to the managed care area following the MFP steps. Revised: 4/23/2012 39
SAS Help File Note: If the consumer is leaving the nursing facility on the first of the month and will begin services the same day, no one-day authorization is needed. If he is leaving on any day after the first of the month, the SPSU will complete the one-day authorization so that services can begin upon his arrival in the STAR+PLUS service area. Example: The MFP consumer is determined eligible for CBA on 11/17/11. He plans to discharge from the nursing facility 11/20/11. Upon his arrival in the STAR+PLUS service area, the SPSU will enter a one-day authorization for 11/1/11-11/1/11. The SPSU will then enter the initial SPW eligibility into SAS with an effective begin date of 11/20/11. Mutually Exclusive Services within SPW To close services that are mutually exclusive, the DADS case manager must close the DADS’ services with an effective date one day prior to the date the member is eligible for SPW services. For example, if a DADS consumer receiving Family Care (FC), Emergency Response Services (ERS) and Home Delivered Meals (HDM) becomes eligible for SPW services on 12/01/11, he will begin receiving his services through his MCO on that date. Therefore, the losing DADS case manager must close the FC, ERS and HDM services with an effective date of 11/30/11. MDCP Age Out to SPW The SPSU will enter the initial SPW eligibility into SAS using the steps for Initial eligibility with one exception. The Effective Begin Date for all the records will be the 21 st birthday. It is possible the Medical records (MN/Level of Service/Diagnosis) will have to be extended to cover the entire ISP period. Terminations / SPW The Enrollment and Service Authorization records must be closed in SAS when all services for an existing SPW member are terminated. When Enrollment is terminated, the authorizing agent has to manually terminate each SPW service authorization record. Terminating All Services / SPW To terminate all services for an existing SPW member: Revised: 4/23/2012 40
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 30 and 31: United Healthcare Nueces 1014437 Un
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 44: 1. Search for the member’s SPW ca

(spw) sas help file

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