authorized representatives missouri hospital association missouri family support division
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AUTHORIZED REPRESENTATIVES
MISSOURI HOSPITAL ASSOCIATION
Missouri Family Support Division
Welcome!
Presenting from Missouri FSD:
Julie Gibson, Designated Principal Assistant Glenda Deason, Manager, MHABD Medical
Review Team Processing Center, Springfield, MO Linda Simmoneau, Program Development
Specialist, Medical Review Team
FSD Modernization and Reorganization
Upgrading to new/modern technology – MEDES – replacing existing legacy system (FAMIS) Web-based, automated system Stronger case management tools Cheaper to operate and maintain
Phase I -- MEDES – MAGI Medicaid (January, 2015)
Phase II will focus on Non-MAGI Medicaid (elderly, disabled) – (2016)
FSD Reorganization
Key Elements of FSD Reorganization: Centralizing application processing/
specialized customer services Creating Customer Resource Centers
throughout the state Employing call center technology and
processes Converting paper case files to electronic
format
WHAT CHANGES WILL YOU SEE?
How does this impact Authorized
Representatives?
MHABD MRT Specialization “MRT Central”
MRT Central will enable faster and more efficient processing and will provide a centralized point of contact for Authorized Representatives
Consolidates processing of MHABD MRT to one primary location – Greene County, Springfield, MO
Eligibility staff and Medical Review Team work hand in hand to expedite processing of MHABD MRT applications from start to finish
MRT Central staff become a “specialized team” in processing MHABD MRT applications
Partnership with Authorized Representatives
MRT Central values the important partnership with ARs and is committed to providing excellent customer service
STL AR is transitioning operations to MRT Central – all information sent to the STL AR Group will be forwarded to MRT Central via e-mail
Please begin using this new email address that has been established solely for applications from hospitals and facilities:
MAKE SURE THAT THE APPLICATION AND OTHER
REQUIRED FORMS ARE COMPLETED THOROUGHLY
How can Authorized Representatives help expedite processes?
MHABD Forms
IM-1MA Application for Benefits IM6-AR – Appointment of Authorized
Representative MO-650-2616 – Authorization for Disclosure
of Consumer Medical/Health InformationIM-61B – Disability QuestionnaireIM-61C Work History in the past 10 years IM-61D Hospitals, Medical Facilities and
Physicians seen within the Past Year
MHABD Verification Forms
IM-9 Insurance and Prepaid Burial Verification Request
IM-12 Employment Information Verification Request
IM-7 Financial Information Verification Request
IM-1MA Application for Benefits
Tips for Completing the IM-1MA Application
If applicant is homeless – be sure and note this on the application and include a mailing address – which can be the hospital/authorized representative’s mailing address
Ensure that the type of application is marked, i.e. disabled, over 65, blind/visually impaired. If client is wishing to pursue Gateway to Better Health, please write that in
If married and living together, both spouses must be listed on the application
All types of income, earned or unearned, should be listed on the application
IM-1MA (Cont’d)
Make sure all resources are indicated on the application
Ensure that the application is signed and datedPlease make sure we receive the completed application
as soon as possible, especially if it is late in the month For example, if the client fills out the application and it is dated for March 30, but we don’t receive it until April 1, then April will be the month of application
If the client does not have unpaid medical bills prior to the month of application, it may not be necessary for you to go through the need of obtaining information for the months prior (see next slide)
Prior Quarter Coverage
Indicate on the application whether or not prior quarter coverage is needed.
MOHealthNet may cover outstanding medical costs incurred by the applicant (or spouse) in the 3 months prior to the month application is received
All types of income, earned or unearned, should be listed on the application, including prior quarter
Make sure all resources are indicated on the application, including any owned in the prior quarter
Options for Authorized Representatives
Consider the level of involvement you want/need to have on behalf of a client
FSD allows for several options that will enable a provider to assist the client:
1) Become a legal Authorized Representative by completing IM-6-AR
2) Client can give FSD permission to discuss his/her specific case with you (without making you
an official AR) by notating on the MO-650-2616 (HIPAA form) 3) Client can give FSD the same permissions as # 2 by completing the newly created IM-6-NF
IM6-AR Appointment of Authorized Representative
IM6-AR – Appointment of Authorized Representative
As an Authorized Representative, you become FSD’s primary contact for the client: Represent the client in Hearings Receive all correspondence on behalf of client Access to client case information Speak to FSD on behalf of the client
In completing the IM-6-AR: Ensure that this form is completed in its entirety Must be signed by the Authorized Rep, or it cannot be
accepted Make sure that the form is legible Please print your name behind your signature
MO-650-2616 – Authorization for Disclosure of Consumer Medical/Health Information
MO-650-2616 – Authorization for Disclosure of Consumer Medical/Health Information
This is often the most confusing form for the client to complete
Please have the client sign this form in black ink. MRT Processing must have signatures that are visible
in order to obtain the appropriate medical records needed /schedule necessary evaluations
Ensure that both signature lines are signed on the back of the form
Make sure that the individual has NOT signed the revocation area
IM-6-NF AUTHORIZATION FOR RELEASE OF MEDICAL/HEALTH INORMATION TO THE NURSING FACILITY
IM-6-NF AUTHORIZATION FOR RELEASE OF MEDICAL/HEALTH INORMATION TO THE NURSING FACILITY
A user-friendly form that gives FSD permission to discuss a person's case with the provider
Alternative to the IM-6-ARDoes not make the provider the Authorized
Representative
IMPORTANT TO ENSURE THAT THEY ARE COMPLETED AND
SUBMITTED
Other MRT Forms
IM-61B – Disability Questionnaire
IM-61B – Disability Questionnaire
This form is the voice of the individual when MRT is making a determination.
Must be completed thoroughly MRT Processing must know ALL medical
conditions of the individual This form also helps to determine if any other
evaluations need to be scheduled for the client
IM-61C Work History in the past 10 years
IM-61C Work History in the past 10 years
FSD must obtain employment information for the past 10 years
The individual must make every attempt to provide accurate and complete information
IM-61D Hospitals, Medical Facilities and Physicians seen within the Past Year
IM-61D Hospitals, Medical Facilities and Physicians seen within the Past Year
Provide information for all medical services the individual has received in the most current year
FSD will not be requesting records older than one year
The dates of service are critical to obtaining the relevant medical records – be sure to include them
IM-9 Insurance and Prepaid Burial Letter
IM-9 Insurance and Prepaid Burial Letter
This form is required if the individual has any life insurance or burial policies, and must be completed and signed by the client
The name of the company is requiredThe company address is requested, if
available
IM-12 Employment Information Request
IM-12 Employment Information Request
This form can be supplied if paystubs are unobtainable by the individual
Ensure that the form is signed Ensure that the employer name and address
is provided: It is very important that we know the location of
the employer where the client works/worked, especially since many are franchised or have multiple locations
IM-7 Financial Information Request
IM-7 Financial Information Request
This form is completed by a bank/financial institution, and is necessary if the client does not have access to, or does not provide their financial institution/bank account verification
If the individual has access to their information, please have them attempt to obtain the information themselves, as some banks charge a fee for filling out the IM-7
MHABD Authorized Representative Case Status Report
Starting April 1, 2015: AR will receive “Vendor” Case Status Report Semi-Monthly
Two “Vendor” Case Status Reports E-mailed to AROn 1st each month status for prior month
from 16th to last dayOn 16th each month status for current
month 1st to 15th
Will develop a customized report for ARs in the near future
MHABD AR Case Status Report (Cont’d)
Current “Vendor” Case Status Report contains the following fields:
Participant Name (AR) Case Number (for AR zeroes) Application Date Referral Received Date Application Status
Pending Approved Not Eligible
Effective Date of Status
Vendor Case Status Report
Final Notes
This email address is monitored 100% of every business day
MRT Central will follow-up on any pending AR applications
If you do have an urgent matter, you may call Glenda Deason at 417-895-6062
Also, check out our updated website at dss.mo.gov/fsd/