Member Call Center Network Providers Training on New Enrollment - PDF document

Member Call Center Network Providers Training on New Enrollment & Slot Scheduler Effective June 8, 2015 , Member Call Center (MCC) will no longer approve enrollments prior to making a referral to our Network Providers. MCC will begin to utilize the “hand over to provider” function for new member enrollments. This will ensure that the providers are able to access the member’s screening and triage information as it relates to the referral. Frequently Asked Questions Can I change any non-clinical Any information that MCC staff enters information in the Enrollment once it is into the enrollment should NOT be handed off from MCC? changed or altered. Will a provider be able to view the Yes. Once the MCC selec ts the “hand member’s New Enrollment within the over to provider” option, the provider Alpha system? will be able to view the Enrollment, including triage & presenting problem information. Will the provider continue to receive No existing Enrollment PDF files via email from MCC? Can both a provider and MCC manage / No; the Scheduler will be managed by drive the Scheduler at the same time? one or the other [depending on provider’s “open access” status ]. Member Call Center Effective June 8, 2015

How does a provider create Go to Provider Scheduler appointments on their Scheduler? Select the Site Select “Get Site Schedule” Select date/time…double click Complete required fields Save *providers can create appointment recurrences Please refer to Network Operations webinar training titled “Eastpointe Alpha Scheduler Training” How does a provider drive their The provider will need to create an Scheduler when they are a walk-in crisis appointment titled “Walk - in” in the center and manage appointments? subject line. This appointment episode can have multiple slots. This will allow MCC staff to connect members to a provider as a “walk - in”. How does a Crisis Walk-in Center The Crisis Walk-in Center should be in manage their Scheduler when they do “open access” status so that MCC staff NOT manage appointments? can drive the Scheduler and connect members. How should a Mobile Crisis provider The provider will need to create an manage their Scheduler? appointment titled “Mobile Crisis” in the subject line. This appointment episode can have multiple slots. This will allow MCC staff to connect members to the Mobile Crisis provider. OR The Mobile Crisis provider can be in “open access” status so that MCC staff can drive the Scheduler and connect members. Member Call Center Effective June 8, 2015

How does a Walk-in Clinic or Mobile Please contact Network Operations at Crisis provider become “open access” 1-888-977-2160 status? Does a provider put internal No. The Scheduler is only for MCC to appointments on the Scheduler? utilize in the referral process. Can a provider delete an appointment If it is an open/available appointment, from the Scheduler? YES . If a member is already scheduled in the appointment slot, NO . The system will not permit this action. What happens if a provider schedules If the appointment is still available an appointment internally and needs to within the Scheduler, the provider remove the appointment from the needs to delete the appointment slot to Scheduler? prevent double-booking of the appointment. If an appointment already exists within the Scheduler, the provider should not schedule internally. What happens when MCC staff The MCC cannot manage a provider’s schedules an appointment on the Scheduler if they are not identified as Scheduler that is not a true “open access” status. Therefore, if MCC appointment? schedules an appointment on the Scheduler, that means that the provider created the appointment for MCC staff to utilize. The error is not on the side of MCC. What does the provider need to do if The provider needs to create the verbal MCC calls the provider to obtain an appointment on the Scheduler in order appointment? for MCC to connect the member. The subject line needs to reflect that the appointment slot is already filled [ex. “Appt . Taken”] Member Call Center Effective June 8, 2015

Does a provider need to add members No…again, the Scheduler is only for to the Scheduler if the member MCC use to make referrals to providers. accesses the agency directly (meaning NO MCC referral)? When does the follow-up need to be Depends on the triage level: Routine  within 24-hours of the completed? appointment Urgent  by the end of the business day of the appointment Where will providers find the member’s New Enrollments : triage level? Triage level is identified as the “Need Severity” Existing Members : Triage level will be found within the Presenting Problem and entered within th e “Notes” section in the Scheduler. Do providers need to add existing NO…appointment follow -up members on the Scheduler in order to information is only needed for initial report appointment follow-up access to care referrals. Providers do information? not need to report follow-up information on concurrent appointments. Remember: if member reschedules initial appt., this follow-up information is needed. FAQ from Webinars June 3-4, 2015 Why are we receiving referrals from members If MCC staff schedules an IPRS member in a that do not have any insurance? Medicaid appt slot, please contact MCC so the member can be rescheduled appropriately. For appt follow-up status, please select “Referral Not Accepted” After 6/8/15, enrollments will or will not be MCC staff will NO longer approve new approved? enrollments. Once it is handed over to the provider, the provider will complete the enrollment & submit to Medical Records; this dept. will review for approval. Member Call Center Effective June 8, 2015

How do you prove income for Medicaid DSS is responsible to gathering income recipients? I thought DSS does that? information as it relates to Medicaid eligibility. This is different than the income question on Are we to ask for check stubs, etc. for the New Enrollment. Medicaid members to verify income? Per Medical Records, “ We want as accurate information as possible but we have taken the members word”. Therefore, you can enter the verbal income information given to you, or ask for proof via check stubs. This will be determined on your agency’s protocol. There are no changes if the member comes to Correct. If member accesses a provider use directly, correct? directly, MCC does not need to be involved in the enrollment process. The provider will continue to be responsible to completing the New Enrollment and submitting to Medical Records for review. Is new member enrollment only for IPRS New Enrollment process should be completed patients or Medicaid patients as well? for IPRS and Medicaid members. For the appointments that were in the old You can call MCC with this follow-up system, how do we let Call Center know if they information. showed or no showed? What do we do if the Call Center schedules an The MCC cannot manage a provider’s appointment and we have a conflict with an Scheduler if they are not identified as “open already scheduled appointment? access” status. Therefore, if MCC schedules an appointment on the Scheduler, that means that the provider created the appointment for MCC staff to utilize. The error is not on the side of MCC. Please see response to FAQ, “ What happens if a provider schedules an appointment internally and needs to remove the appointment from the Scheduler ?” How do you know when to do a client update Please refer question to Network Operations or the enrollment? and/or Medical Records. What will we be using in place of the STR? MCC will document STR information within the New Enrollment and/or Alpha Call Base. Please see response to FAQ, “ Where will providers find the member’s tria ge level ?” Member Call Center Effective June 8, 2015

For walk-in crisis, how will we report back who Via the Scheduler has come in for services? Can Call Center see the description section of Yes the scheduler? When you give providers the rights for No information completed by MCC on a New member enrollment, will we be able to make Enrollment should be changed, edited, or our own changes without going through client altered. update? What is the best way to search if the member For New Enrollments, the enrollment ID has an enrollment in Alpha? number should be available on the Slot Scheduler. It should be part of the information that Alpha filters in from the referral process. You can also search using the member’s name, DOB, and/or SSN. For old enrollments, providers cannot access this information in Alpha. How do we select Medicaid and state funding You can select “all funding” and notate for one appointment; it only allows us to pick “Medicaid & IPRS only” in the description. one or the other? In the past with ProviderConnect, we were List “JJSAMHP” in the subject line. able to add appointment slots for JJSAMHP referrals, how we will be able to do this now with the Scheduler? If you have any additional questions, please contact Network Operations at 1-888-977-2160 Member Call Center Effective June 8, 2015