KanCare: Reinventing Medicaid for Kansas

Providers

HCBS Waiver Provider Forum

Frequently Asked Questions


5.17.13

  1. Q: Deon Wilson (CIL)- FMS provider – have the MCO’s decided if there is a standard method for calculating plans of care? 
  2. A: Sunflower – started out with different methodology – but now using 5 weeks for each month, Amerigroup – using 4.5 weeks per month, United – using exact calendar days;

    Q: if we haven’t received a new POC, what do we do?
    A: Keep using current plan


     
  3. Q: Sage – FMS provider – Q: POC/Auth –several with no auth – how do we bill;
  4. A: Amerigroup – we will call you – we are working them; Sunflower – you can check provider portal, we will have a provider rep get in contact with you, United – we will call you – we are working with providers – often we have auth in our systems but not in AuthentiCare;

    Q: billing question from Bobbie - for United – we are only being paid 40% -
    A: we had system error - thought we had errors corrected – we will reach out to you


     
  5. Q: Jacque Clifton – FMS provider – Q: value added service of respite and overnight respite – since you are not contracted provider you can’t bill for those – Amerigroup will contact you; Sunflower – contact CM Sarah Kirgen for I/DD pilot services, for FE waiver this value add is flat rate with no admin fee; United – we don’t have this as value add but will follow up with you.  Q: value adds get sent to FMS but we don’t get an admin fee; plans will follow up with Jacque

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  7. Q: Michael – ILRC – FMS – Q: biggest problem is truant POC with errors + POC is back dated, can we expect improvements on this?  Providers turning in timesheets rather than using AuthentiCare  
  8. A:  Amerigroup, Sunflower, United: we did have a backlog, but we are working on improved process, you should see improvement here. 

    Q: If MCO creates back dated POC and provider submits time sheets to FMS but this is not in AuthentiCare FMS contract says we can only pay if the hours are in AuthentiCare – should we pay? 

    A: Program managers will discuss with KDADS leadership regarding FMS agreement with KDADS and provide feedback to FMS providers.

    A: State will begin next call with a POC process walk through from each MCO


     
  9. Q: Anthony – The Whole Person – FMS – POC time line issues – maybe we could get communication from CM from MCO if POC changes; A: if decrease, we are giving ample time to implement, if there is an increase, we will discuss this but with our new process and if we are more timely on the POC.  Kim suggests interim communication if POC is not timely to FMS

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  11. Q: Denny Leak – Autism – Rainbow United – Q: annual POC maintenance question – used to be on KMAP now not,
  12. A: State staff will contact you and we will work with MCO’s on this process.  Q: United asked for Denny’s help to review process, United not supporting certain academic treatment goals that they had previously – we’ll contact you back.


     
  13. Q: Amy – TILRC – FMS – Transition coordination services MFP – intersection between program rules for waiver services and limitations and POC’s – program limit of 10 hours a day except for exceptions – how does this work in this environment? 
  14. A: MCO’s approve exceptions.  POC is written with weekly limits per program manuals but MCO’s are doing this differently – see above – question 1.


     
  15. Q: Lori Angelo – Autism – how to get contracted for value added respite for Autism for Amerigroup – Amerigroup will contact her back; POC errors, please communicate answer to #6 to whole group

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  17. Q: Kari Layman – FMS – Q: Can MCO’s do same calculation/forms
  18. A: Send us forms.  We received forms and request to standardize, thank you Kari.  State and MCO’s to take this into consideration.


     
  19. Q: John with NE ADRC - Q: transportation arrangements – who to call at each MCO,
  20. A:  United – Logisticare, Amerigroup – Access to Care, Sunflower – Logisticare - just call main number. 

    Q: What is schedule for MCO CC seeing people
    A: Amerigroup – At minimum: Face to face on quarterly basis, United – face to face every 6 months, will contact quarterly but with TA monthly, Sunflower – same as United or more frequently as needed


     
  21. Q: Jessica – FMS – if MCO’s don’t get POC done by day 180, then what
  22. A: MCOs are expected to complete the plans of care within the 180 days.

    5.21.13

    Managed Care Organization (MCO) Plan of Care (POC) Processes

    Amerigroup, Sunflower, and United HealthCare Plan of Care Process information and MCO contact numbers will be posted soon on the KanCare website for reference.

    Follow‐up from Last Session 5‐17‐13

    4. Q: If MCO creates back dated POC and provider submits time sheets to FMS but this is not in AuthentiCare, FMS
    contract says we can only pay if the hours are in AuthentiCare – should we pay?

    A: Program managers will discuss with KDADS leadership regarding FMS agreement with KDADS and provide feedback to
    FMS providers. (5.21.13 Update ‐ This item is in process)

    A: State will begin next call with a POC process walk through from each MCO (5.21.13 update – this item was completed in the 5.21.13 session – see section above in notes and attached).

    Frequently Asked Questions

    1.   Q: Stacy Jones – (Helpers, Inc.) ‐ FMS provider – What documents should we expect from each MCO for audit purposes and in what method (fax, e‐mail, mail)?
    A: Amerigroup – An Approval for Services form, a 2160 (Task & Hour Guide) with tasks for member, and a
    Service plan. These documents will be faxed.
    A: Sunflower – An Authorization letter and POC with approved units. These documents are usually received via fax, but could be via e‐mail or mail.
    A: United ‐ Authorization Confirmation via fax with a Service Plan via mail. The POC has the service breakdown.
    UHC is in the process of revising their POC form based upon feedback from providers for better clarity.

     

    Q: Value Added Respite (Amerigroup) – how would we be reimbursed for services if we do not have a contract with Amerigroup yet, so this service would be a non‐reimbursable service?
    A: Amerigroup – We will be meeting about this, how to amend your contract and get you paid.

     

    2.   Q: Carol Pantle (Accessible Home Health) – Home Health provider – If the person changed providers in the middle of the month, what provider gets paid the Administrative billing fee?
    A: Amerigroup – We will pay the first one that comes in since they can only pay 1 per month.
    A: Sunflower – Their process is consistent with Amerigroup’s answer and will help person with transition. A: United – They will pay the provider in place at the beginning of the month and coordinate services. State: First claim for that month or first provider?
    A: Amerigroup – First FMS Claim and First FMS fee the next month.
    State: The State will take this question back to the State‐MCO Workgroup meeting for more discussion.

     

    3.   Q: Sage Tebeest (Three Rivers Inc.) – HCBS provider – when will providers see notification of closures?
    A: Amerigroup – We are starting to notify providers now using a file received monthly indicating a person has changed. They are working on a formalized process since there are different sources.
    A: Sunflower – We are working on developing tools when a case is closed. In the next couple of weeks,
    providers should see case closure information.
    A: United – When there is a case closure to another MCO, we do not currently send a notification to providers. Providers should be checking KMAP.

     

    Q: Why would providers not receive closure information when a person changes MCOs? Due to this, we provided 4 months of services without any reimbursement.
    A: United – Providers should be checking KMAP and web provider portal. Provider rep’s can also assist providers.

     

    4.   Q: Deone Wilson (RCIL) – FMS provider – question about activity codes. MCOs are not providing these and we are concerned about audit issues.
    A: State – This is an issue for the State. The tasks should still be tracked. The State will take this question back to the State‐MCO Workgroup meeting for more discussion.
    Q: What should providers do in the interim? Will there be a grace period? How will providers determine what
    is their responsibility?
    A: The State will have to determine tasks and logistics. The State will take this question back to the State‐MCO Workgroup meeting for more discussion.

     

    Q: Will the State Policies and Procedures be updated?
    A: State – Internal discussions are occurring during the State‐MCO Workgroup meetings and steps being made to consolidate the State Policy and Procedure manual with the MCO Provider Manual.

     

    5.   Q: Kathy Crouch (SKIL)– FMS provider – concerned about provider obligation notifications. United currently informs providers. How do providers get this information from the other two MCOs?
    A: Sunflower ‐ Providers should be looking up people in KMAP and the Provider Portal. Sunflower is trying to
    develop a roster with client obligation information to prevent individual piece of paper notification for each member.
    A: Amerigroup ‐ Amerigroup is discussing a process to mail out letters. The issue for them is the timeframe from getting the file from the State and notifying providers timely.

     

    6.   Q: Fae Cole (Complete Home Health Care) ‐ FMS provider – If a member dies during the first week of the month with client obligation, will the fee be pro‐rated?
    A: Amerigroup – The FMS fee should be billed at the beginning of the month before the client has passed away.
    The client obligation question is a State question. A: Sunflower – Same process
    A: United – Same as other two MCOs. The FMS admin fee should be billed at the beginning of the month to still get paid the admin fee.
    A: State – Client obligation is not pro‐rated, but the State will follow‐up with the Division of Children and
    Families (DCF), a different State agency.

    Q: Still not clear on person changing from one agency to another. Does payment go the original provider assigned?
    A: Amerigroup – The admin fee can only be paid once per month.

     

    7.      Q: Janet Williams (Minds Matter) –Protected income and Client obligation – who is educating the person about protected income?
    A: Amerigroup – This is an eligibility question.
    A: State – Previously before KanCare, this was a Case Manager responsibility. The State will follow‐up with DCF
    to ensure who is telling member about protected income and what the client obligation is. A: United – Care Coordinators can discuss. United does send a letter to the member.
    A: Sunflower – The member and the MCOs get a copy of the letter from DCF with the client obligation information. When staff is out at a member’s home, they do an assessment and discuss. The amount is done through the eligibility process. There is no separate letter from Sunflower.
    A: Amerigroup – A letter is not sent to the member about obligation from Amerigroup. Client obligations are assigned to the highest service and discussed when visiting the member on whom to pay client obligation to. Client obligation is only applied to certain codes and does not come off the FMS fee, but usually to Attendant care.
    A: United – It will be deducted from personal service codes.

     

    8.     Q: Becky White (Medicalodges) – The 180 day grace period for POC has ended. We are still missing 130 POCs and documentation.
    A: State – The 180 day initial POC period does not end until 6‐30‐13. The State will not be expanding the grace period.
    A: Amerigroup – We do not believe we have any members pending. We will call you. A: Sunflower – We will call.
    A: United ‐ We will call.

5.28.13

Follow‐up from Last Session 5‐21‐13

4. Q: If a MCO creates a back dated Plan of Care (POC) and provider submits time sheets to FMS but this is not in
AuthentiCare, FMS contract says we can only pay if the hours are in AuthentiCare – should we pay?

A: Program managers will discuss with KDADS leadership regarding FMS agreement with KDADS and provide feedback to
FMS providers. (5.28.13 Update ‐ This item is in process.)

Frequently Asked Questions

1.   Q: Sam Curran (Medicalodge) – Issues importing of remittance advice into Authenticare based upon file type
(.rsp versus .txt file). Do providers need to hire a programmer to import?
A: First Data – Import must be EDI compliant. Send sample to Grant with First Data and he will coordinate. Providers shouldn’t need to hire a programmer.

 

Q: Is there a State contact as well?
A: State – Contact Brad Ridley at 296‐6455 (Brad.Ridley@kdads.ks.gov)

 

2.   Q: Lori Walters (OCCK) – FMS provider – When will United be able to authorize MFP through Authenticare?
A: United – This is in process and should have the ability to authorize by the end of June (July 1).

 

Q: When a Care Coordinator corrects a POC, what is the length of time to see in Authenticare?
A: Sunflower – It usually takes at least 3 days, but Sunflower prioritizes if urgent as in the case of new members who would not have an existing POC. If there is an increase, it could take another couple extra days.
A: United – Process is similar to Sunflower. They prioritize new members. If there is an increase, it could take
longer.

 

3.   Q: John Griddell (Life Patterns) – FMS provider – Can a day be adjusted (overlapping times to adjust a day for billing)?
A: United – If you can’t submit through Authenticare, submit the day directly through the State’s front end
billing.
A: Sunflower – Reach out if you are having issues.

 

While the group was waiting for more calls to come in on the queue, Lori with Sunflower asked any interested FMS providers to send her feedback on POC tasks/activities. Would it be sufficient on a POC to have separate activities broken out with hours/week and weeks/month (Agency‐ direct or Self‐direct) without a full needs assessment?

6.4.13

42 total participants
Sharilyn Wells – Independence Inc.

Q:   More than one service time on the same day, made mistake on entering most of the day, then entered another shift for that same date of service another time.  How do I adjust the claim to add the additional time?  How do I correct an incorrect billing to Amerigroup?
A: Amerigroup will reach out to you and walk you through the process of how to correct this claim
Becky Brewer - RCIL, FMS provider


Q: United MFP billing problem (IT issue), when will this be fixed?
A: We thought it would be fixed this past week, unfortunately it was not, we are working hard to fix.  Q: Can folks get paid in the interim?  A: We will outreach and discuss an option for interim with you to get folks paid.


Q: weekly authorizations rather than monthly causing problems with billing when units are exhausted.
A: If over 999 units per month, UHC’s system can’t handle it (only accepts 3 digits), so have to break into weeks.  United is working on a fix for this and will update us with an ETA ASAP.
Debra Bloomquist – wants us to continue these calls


Q: TA waiver referral – who do we contact at MCO to make the referral for existing MCO members
A: Amerigroup: Margaret Zillinger, Sunflower: Jana Gober, United: Tonya Hamilton


Q: Various issues with FMS providers –how are we addressing
A: We have FMS workgroup that has started meeting that will address issues.  State will address issues and communicate notes – will let you know how ASAP
Ami Hyten - TILRC – FMS provider and Center for Independent Living


Q: What is process for notifying agencies that will provide transition coordination services for MFP?
A: Sunflower:  will contact you directly via phone, United: will call you, Amerigroup: will call you


Q: what is process for coordination between DCF, MCO and EVV regarding loss of Medicaid eligibility?
A:   Per First Data: authorizations are not end dated by MCO’s.  The Client entity screen shows where waiver eligibility ended; per MCO’s you should look at KMAP to discover if client is eligible.  If providers notice loss of eligibility, please notify MCO (as you may know about it before DCF updates record, and therefore before MCO knows about it).
Elder Care Inc. - Donna – Home Health


Q: 40% of clients with no POC, what do we do?
A: A: reach to Margaret Zillinger, S: reach to Marc Shiff, U: we will reach to you
Debra Bloomquist


Q: is FMS workgroup including the issue of ACA health insurance mandate?
A: yes