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April 9th, 10:30 AM, STAR Kids MCO/Member/Provider Stakeholder Workgroup - Meeting Reminder and Agenda

By J.R. Top posted Apr 05,2018 01:44 PM

  
The telephonic STAR Kids MCO/Member/Provider Stakeholder Workgroup meeting being will be held on April 9 at 10:30 AM. A copy of the agenda is available at the following link: https://www.dropbox.com/s/d3yp630f29ou0ob/20180409%20STAR%20Kids%20Workgroup%20agenda.docx?dl=0

Call Information: 877.820.7831
Access Code: 590037

Agenda:

1. HHSC Updates

 

 

Topic

Lead

Today’s Discussion

 

1.      

Member Portal update

MCCO

 

 

2.      

FMSA/MCO meetings

TAHP

 

 

3.      

Eligibility 

PES

 

 

4.      

Other

 

 

 

 

Ongoing Action Items

Description

Status

Assigned to

1.      

Eligibility – SSI Members

Inquire with the eligibility area on what would be acceptable to display regarding SSI information.

Open

PES

2.      

Presentation on Eligibility Process

Outreach to AES on conducting a presentations regarding the eligibility process.

Open

PES

3.      

Service Coordination Education

Look into creating a sub workgroup with Ivan Libson, PSU, MEPD, provider representatives and parents regarding expectation on roles/communication.

Open

PES

4.      

Request Form Concerns

United to contact Vicki Gilani (or was this Jackie?) regarding her concerns on their request form.

Open

United

5.      

Guidance on Hospital Discharges

HHSC Policy to provide direction to providers on how to handle issues when members are being discharged from hospitals.

Open

PPD

6.      

Service Coordination Turnover

Service coordinator turnover report added to the UMCM/Sept 1, 2018

Open

HHSC

7.      

Communication with FMSAs and MCOs

Schedule calls with FMSAs and MCOs to discuss concerns/HHSC and TAHP/TBD

Open

TAHP

8.      

MDCP MN eligibility

Request for MN eligibility for August and September 2017/HHSC/TBD

Open

MBD

9.      

MDCP eligibility

Develop a flowchart on MDCP eligibility for reassessments

Open

PPD

 

 

 

Closed Action Items

Description

Due by

Assigned to

10.  1

Survey Monkey

Send survey out to members.

·         Insert results of survey here

·         Time will be split between providers/members.

·         Will implement Option 1. Dates/times will be set. Kari will get with Charles on sending to stakeholders.

Closed

PPD

11.  2

Clarification on definitions

Clarifications regarding the definitions for rendering provider versus service provider.

·         JR sent to Danielle Kailing

·         Kari to follow up with Danielle on any feedback on the language.

Closed

TAHCH

12.  3

PDN/New Rule

Provide additional information surrounding PDN/new rule.

·         There is not a new rule. Clarification updates to TMPPM. Effective March 1, revisions were made. MCOs will be required to follow federal/state/TMPPM.

·         Next step are the code updates to be same as TMPPM; and align to billing matrix. Provider notification was sent out around late February. Discontinuing the use of a couple of codes and adding a modifier.

Closed

PPD

13.   

Coverage of benefits

MCOs will develop and disseminate a one pager on primary and secondary insurance

Closed

TAHP/PTFK

14.   

NPI and rendering provider

Guidance on NPI and rendering provider

Closed

MBD

 

 

 

Requested Agenda Items

Description

Assigned to

15.  4.

Update on Claims Alignment Policy for MCOs and Fee-for-Service

Will be added to the next meeting agenda.  JR to provide examples no later than April 3rd.

TAHCH

16.   

STAR Kids therapy services Delivered at Private Schools during School Hours Policy Clarification

Will be added to the next meeting agenda. JR to provide examples no later than April 3rd.

TAHCH

17.   

Loss of paperwork

Add to next agenda - Providers are experiencing paperwork being lost during the transition of when a member is discharged from hospital to home. Providers should continue to send to health plans.

n/a

18.   

Therapy access

Increase in partial and full denials

Difficulties discussing concerns with authorization teams because certain MCOs do not allow for reconsideration and will only allow you to appeal

Concerns with the methods used to issue denials.

n/a

19.   

MCO employees showing up at children's private physician's appointments

Additional information requested by HHSC on March 12, 2018. Once additional information is received, this item will be added to the family/member agenda.

PTFK

20.   

New therapy forms being required by Optum. Additional PCP appointments required for "therapy screening"

Additional information requested by HHSC on March 12, 2018. Once additional information is received, this item will be added to the family/member agenda.

PTFK

 

Hearing screening requirement causing access to care issues

Additional information requested by HHSC on March 12, 2018. Once additional information is received, this item will be added to the family/member agenda.

PTFK

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