Liberty Healthcare PCS Provider Training May 2019

Leading Today, Empowering Tomorrow

Welcome

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8:00-9:00 am Registration

9:00-9:15 am Welcome and Introductions Denise Hobson - Executive Director; Liberty Healthcare

9:15-9:30 am PCS Updates Jeremy Owen - Director of Operations; Liberty Healthcare

9:30 - 10:30 am General Session: Medicaid Managed Care Sabrena Lea - Associate Director, Long Term Services & Supports; NC Medicaid

10:30 -11:15 am Q & A Session

11:15 – 11:30 am Break

11:30 – 12:30 pm Break Out Session I

Room A – Electronic Visit Verification

Room B – Provider Portal

Enhancements

Cassandra McFadden - Program Operations Manager; NC Medicaid Emonique Wooten-Whitfield - Business Analyst; VieBridge Inc.

Meeting Agenda

3

12:30 – 1:30 pm Break Out Session II

Room A – Electronic Visit

Verification

Room B – Provider Portal

Enhancements

Cassandra McFadden - Program Operations Manager; NC Medicaid

Emonique Wooten-Whitfield - Business Analyst; VieBridge Inc.

Meeting Agenda Continued

PCS UPDATES

Presented by: Jeremy Owen, Liberty Healthcare

5

Clinical Coverage 3L Policy Updates

What is new?

Updated policy effective

March 15, 2019

RSVP Language (updated Nov 2018)

PHP reference added to Table

of Contents page.

6

Service Plan Compliance: Key Points

6.1.4 Requirements for State Plan PCS Online Service Plan

Provider organizations accepting the IAE referral to provide PCS shall review the IAE independent assessment results for the beneficiary being referred, and develop a PCS service plan responsive to the beneficiary’s specific needs documented in the IAE assessment.

The service plan must address each unmet ADL, IADL, special assistance or delegated medical monitoring task need identified in the independent assessment, taking into account other pertinent information available to the provider.

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Service Plan Compliance: Key Points

The provider organization shall ensure the PCS need frequencies documented in the independent assessment are accurately reflected in the PCS service plan schedule as well as any special scheduling provisions such as weekend days documented in the assessment.

The provider organization shall ensure that the beneficiary or their legally responsible person understands and, to the fullest extent possible participates in the development of the PCS service plan.

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Service Plan Compliance: Key Points

The PCS service plan must be developed and validated within seven (7) business days of the Provider accepting the IAE referral.

In addition, the provider organization shall obtain written consent in the form of the signature of the beneficiary or their legally responsible person within 14 business days of the validated service plan. This signed service plan must be uploaded into ‘Supporting Docs’ in the

Provider Portal.

Choose ‘Beneficiary Service Plan Consent Form’ as the Record Type when uploading.

Additional requirements for the State PCS Online Service Plan can be found in Clinical Coverage Policy 3L, Section 6.1.4.

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Service Plan Compliance

When does a PCS Provider complete a service plan?

Required each time an assessment is completed or referral accepted.

Required any time there is a change in hours (annual, MCOS, COS, mediation, court settlement).

Required when providing PCS under Maintenance of Service (MOS).

Not a Plan of Care.

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Service Plan Compliance-Reminders

Prior Approvals (PAs) for PCS hours or units are not granted until the online PCS service plan is entered into and validated by the Provider Interface.

Prior Approvals will not be made retroactive for service plans not completed timely.

PAs are only continued with the completion of an assessment, acceptance of the referral, and completion of the Service Plan.

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Provider Requirements & Forms

Important Forms

NC Medicaid-3085: Session Law 2013-306 PCS Training Attestation Form

NC Medicaid-3136: Internal Quality Improvement Program Attestation Form

NC Medicaid-3137: ICD-10

Transition Form

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NC Medicaid-3085: Session Law 2013-306 PCS Training Attestation Form

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NC Medicaid-3085: Session Law 2013-306 PCS Training Attestation Form

N.C. Session Law 2013-306 Providers serving beneficiaries seeking additional hours of PCS due to Alzheimer’s or other Memory Care complications are required to have caregivers with training or experience in caring for individuals who have a degenerative disease characterized by irreversible memory dysfunction that attacks the brain and results in impaired memory, thinking, and behavior, including gradual memory loss, impaired judgment, disorientation, personality change, difficulty learning, and the loss of language skills.

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NC Medicaid-3085: Session Law 2013-306 PCS Training Attestation Form

The PCS Provider Must Include:

Trainer Qualifications - If the training requires qualifications for the trainer, those qualifications should be listed in Part II.

If the training curriculum requires that the course may only be taught by an RN, RN should be documented in this section.

If using an online pre-developed module, list reference to the module.

Curriculum Outline - The curriculum should include the following:

Description of training goals Core competencies Skills Validation General Training Methodology

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NC Medicaid-3085: Session Law 2013-306 PCS Training Attestation Form

Who is required to submit this form?

Any provider servicing or who plans to service a beneficiary that receives additional hours mandated by N.C. Session Law 2013-306.

NOTE: Providers who are non-compliant

with submission of the NC Medicaid-3085

Form are subject to audit by the PCS Unit as well as the

Office of Compliance and Program Integrity.

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NC Medicaid-3085: Session Law 2013-306 PCS Training Attestation Form Submitting the NC Medicaid-3085 Form to NC Medicaid

Complete the NC Medicaid-3085 and submit along with any required materials as noted on the form by:

Email: Medicaid.PCSTraining@dhhs.nc.gov

Mail to: NC Medicaid Home & Community Care

2501 Mail Service Center

Raleigh, NC 27699-2501

Provider Portal: Upload directly to Qi Report

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NC Medicaid-3136: Internal Quality Improvement Program Attestation Form

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NC Medicaid-3136: Internal Quality Improvement Program Attestation Form, Key Points

Required to be submitted to NC Medicaid by December 31st each year;

There is no standard regarding the format of the required documents;

All CQI documents are not required to be submitted to NC Medicaid, just the NC Medicaid-3136 Form.

Providers who are non-compliant with submission of the NC Medicaid-3136 Form are subject to audit by the PCS Unit as well as the Office of Compliance and Program Integrity.

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NC Medicaid-3136: Internal Quality Improvement Program Attestation Form

What are the requirements for the PCS Provider regarding an Internal Quality Improvement Program?

Develop, and update at least quarterly, an organizational Quality Improvement Plan or set of quality improvement policies and procedures that describe the PCS CQI program and activities;

Implement an organizational CQI Program designed to identify and correct quality of care and quality of service problems;

Conduct at least annually a written beneficiary PCS satisfaction survey for beneficiaries and their legally responsible person; and

Maintain complete records of all CQI activities and results.

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NC Medicaid-3136: Internal Quality Improvement Program Attestation Form

Submitting the 3136 Form to NC Medicaid

Complete the NC Medicaid-3136 Form and submit by:

Email: Medicaid.PCSQualityImprovement@dhhs.nc.gov.

Mail to: NC Medicaid A Home & Community Care

2501 Mail Service Center

Raleigh, NC 27699-2501

Provider Portal: Upload directly to Qi Report

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NC Medicaid-3137: ICD-10 Transition Form

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NC Medicaid-3137: ICD-10 Transition Form: Key Points

Effective 10/1/2015, a valid ICD-10 code is required to process a PCS assessment.

The NC Medicaid-3137 form is REQUIRED on every beneficiary before their annual assessment if PCS began PRIOR to 10/1/2015.

All Requests for an Independent Assessment will require a valid ICD-10 diagnosis code effective 10/1/2015.

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Beneficiaries who began receiving PCS services prior to October 1, 2015 were required to submit a NC Medicaid-3137 Form to Liberty Healthcare of N.C. no later than the date of their next scheduled annual assessment.

The NC Medicaid-3137 Form must be completed by the beneficiary’s primary care physician or the practitioner providing care for the medical, physical, or cognitive condition causing the functional limitation.

If a New Request or Medical COS was received after 10/1/2015 with valid ICD-10 codes, that fulfills the requirement for a transition form.

Effective June 1, 2018, QiReport no longer provides a blank NC Medicaid-3137 Form with the annual reminder notification.

Providers may refer to their ‘Caseload’ report in QiReport to identify beneficiaries who still need to meet the transition form requirement.

If the beneficiary has changed providers, the current provider assumes responsibility to make sure this requirement was met.

NC Medicaid 3137: ICD-10 Transition Forms

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NC Medicaid 3137: ICD-10 Transition Forms

PCS Providers are required to submit NC Medicaid-3137 Form to Liberty Healthcare prior to the scheduled annual assessment for each beneficiary currently receiving PCS.

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NC Medicaid 3137: ICD-10 Transition Forms

If the provider accepts a new beneficiary, it is their responsibility to confirm that the NC Medicaid 3137: ICD-10 Transition Form has been completed and provided to Liberty.

To confirm this requirement has been met, the provider should refer to their ‘Caseload’ report in QiReport.

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NC Medicaid-3137: ICD-10 Transition Forms

Completed forms may be submitted to Liberty in one of two ways:

Fax – The PCS Provider or Practitioner can fax the form directly to Liberty at 919-307-8307 or 855-740-1600 .

Upload – The PCS Provider can upload the completed form to ‘Supporting Docs’ through the provider portal.

Providers must select ‘ICD-10 Transition Form’ as the Record Type when uploading.

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Outstanding NC Medicaid 3137: ICD-10 Transition Forms

If unable to obtain form after 3 documented outreach attempts, provider may contact Liberty for assistance.

When contacting Liberty, the provider must provide the following:

Physician Name

Practice Name

Practice Phone and Fax Number

Beneficiary DOB or MID

Dates of all contact attempts

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Location of Forms

All forms with instructions can be found in the following locations:

1. Liberty website: https://nc-pcs.com/Medicaid-PCS-forms/

2. NC Medicaid website: https://medicaid.ncdhhs.gov/forms/

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NC Medicaid 3051 Form & Instructions –New Look

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NC Medicaid 3051

Key Changes to Form

RSID# and RSID Date ICD-10 Diagnoses lines expanded Physician Visit < 90 days from

Received Date Revised Format

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Completing the NC Medicaid-3051 Form

Key Information The NC Medicaid-3051 Form has 6 sections – A through F. You are not required to

complete all of the sections of the NC Medicaid-3051 Form each time you submit the form, just those specific to type of request.

Sections A through D must be completed by the Primary Care Physician or Attending Physician Only (page 1 & 2).

Section E and F must be completed by the Beneficiary, Caregiver, or PCS Provider Only (page 3).

Completion of ALL fields ensures timely processing of the submitted requests. NOTE: Forms received with info fields left blank will be returned to the referring physician. If not completed timely, the request will be denied.

Refer to the Request for Independent Assessment for Personal Care Services (PCS) Form – NC Medicaid-3051 with Instructions available at:

http://nc-pcs.com/Medicaid-PCS-forms/DMA-3051-Request-for-Services-Instructions-and-Form.pdf

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Completing PCS NC Medicaid-3051

Submitting the Completed Form

Complete all appropriate sections Fax the completed form to: 919-307-8307 or 855-740-1600 (toll free) If preferred, forms can be mailed to:

Liberty Healthcare Corporation of NC Attn: Referral Processing Department 5540 Centerview Drive, Suite 114 Raleigh, NC 27606

Reminder: Practitioners must submit pages 1&2, Non-Practitioners should submit page 3. For questions regarding the form, email: NC-IASupport@libertyhealth.com or call 919-322-5944. Keep copies of all forms and fax confirmations for your records.

Medicaid Managed Care Presented by: Sabrena Lea, Associate Director, LTSS, NC Medicaid

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 34

NC Medicaid

Long-Term Services & Supports (LTSS)

Landscape Update for

Spring PCS Provider Training

Sabrena Lea, Associate Director DHB LTSS

May 12-21, 2019

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 35

Long-Term Services and Supports

Care provided in the home or community-

based settings

Care for older adults and people with disabilities who need support

A wide range of services to help people live more

independently

Care for individuals who are at risk of requiring

formal LTSS services to remain in communities

LTSS

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 36

Aged, Blind and Disabled Beneficiaries

NC Medicaid and Health Choice Annual Report SFY 2017 pg. 53

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 37

Non-Elder (under 65) Disability Population is Projected To Grow

NC Money Follows the Person Sustainability Analysis: Transitioning Beyond 2020, May 2018 pg. 86

Mercer

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 38

LTSS in NC Medicaid

The populations using LTSS are

extremely diverse in terms of

individuals’ care needs, service

utilization and spending. Over the

next five years, the transition of

programs that support these citizens

will offer significant opportunities to

improve care coordination, access

to community-based services and

outcomes for these vulnerable

populations….

North Carolina’s Vision for

Long-term Services and Supports

transition to Managed Care

North Carolina’s Vision for Long-term Services and Supports under Managed Care, pg. 1 April 5, 2018

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 39

NC Medicaid Managed Care Vision

“To improve the health of

North Carolinians through an

innovative, whole-person-

centered, and well-

coordinated system of care

that addresses both medical

and non-medical drivers of

health.” -Secretary Mandy Cohen

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 40

PHPs for NC Medicaid Managed Care

Statewide contracts

• AmeriHealth Caritas North Carolina, Inc.

• Blue Cross and Blue Shield of North Carolina, Inc.

• UnitedHealthcare of North Carolina, Inc.

• WellCare of North Carolina, Inc.

Regional contract – Regions 3 & 5

• Carolina Complete Health, Inc.

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 41 41

Prepaid Health Plans

Beneficiaries benefit from

integrated physical &

behavioral health services

“Primary care” behavioral

health spend included in PHP

capitation rate

Phased implementation –

Nov. 2019 & Feb. 2020

Specialized managed care plans

targeted toward populations

with significant BH and I/DD

needs

Access to expanded service

array

Behavioral Health Homes

Projected for July 2021

Create single point of accountability for care and outcomes for Medicaid

beneficiaries through two types of Plans

Standard Plans Tailored Plans

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 42

LINCOLN

REGION 1 FEB. 2020

REGION 2 NOV. 2019

REGION 4 NOV. 2019

REGION 3 FEB. 2020

REGION 5 FEB. 2020

REGION 6 FEB. 2020

CHEROKEE CLAY

GRAHAM

SWAIN

MACON

JACKSON

TRANSYLVANIA

HAYWOOD

HENDERSON

BUNCOMBE

POLK

RUTHERFORD

MCDOWELL

BURKE

AVERY

YANCEY MADISON

CLEVELAND GASTON

CATAWBA

CALDWELL ALEXANDER

IREDELL

ROWAN

CABARRUS

STANLY

UNION ANSON

MECKLENBURG MONTGOMERY

RICHMOND

MOORE

LEE

HARNETT

SAMPSON

BLADEN

PENDER

BRUNSWICK

COLUMBUS

ROBESON

SCOTLAND

HOKE CUMBERLAND

WATAUGA

ASHE

WILKES YADKIN

SURRY STOKES ROCKINGHAM

GUILFORD

RANDOLPH

DAVIDSON

DAVIE

FORSYTH

ALLEGHANY

CASWELL PERSON

GR

AN

VILLE

VANCE

WARREN

FRANKLIN

NASH

WILSON

JOHNSTON

WAKE

DU

RH

AM

OR

AN

GE

ALA

MA

NC

E

CHATHAM

HALIFAX

EDGECOMBE

GREENE

WAYNE

DUPLIN

ONSLOW CARTERET

HYDE

DARE WASHINGTON

BEAUFORT

PAMLICO

CRAVEN

JONES

LENOIR

PITT

MARTIN

BERTIE

HERTFORD

NORTHAMPTON

TYRRELL

GATES

Rollout Phase 1: Nov. 2019 – Regions 2 and 4

Rollout Phase 2: Feb. 2020 – Regions 1, 3, 5 and 6

Managed Care Regions and Rollout Dates

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 43

LTSS Medicaid Population Transition to Managed Care

Tailored

Plan

Eligible

• Managed Care Standard Plan

Enrollees in Year One (Phase 1 & 2)

o Medicaid Only LTSS

• Carved Out/Excluded from

Medicaid Managed Care Enrollment

o Program of All-Inclusive Care for

the Elderly (PACE

o Medically Needy

o Medicaid enrollees in State

Operated Facilities

• Excluded from Managed Care

Enrollment Year 1-4

o 1915c CAP/DA Waiver

participants

o 1915c CAP/C Waiver participants

o Individuals who are dually eligible

(Medicare/Medicaid)

o Medicaid Only enrollees in

Nursing Homes >90 days

*Medically Needy is a Medicaid classification for aged, blind, or disabled

individuals whose countable income and/or resources exceed the

categorically needy limits. Medically Needy coverage extends Medicaid to

needy aged, blind, and disabled individuals who have too much

income/resources to receive SSI, but not enough to pay for medical care. NC Adult Medicaid Manual MA-2120

Managed Care Standard Plan Year 1 Coverage

LTSS SERVICES STANDARD PLAN YEAR-1 EXCLUDED CARVED OUT

PCS Medicaid Only

Home Health Medicaid Only

Nursing Facility Medicaid Only up to 90 days 91+ days

Private Duty Nursing Medicaid Only

Hospice Medicaid Only

HIT Medicaid Only

HIV Case Management Medicaid Only

CAP/C (Children)

CAP/DA (Disabled Adults)

PACE

State Operated NMCs/VAHs

ABD Medicaid Only

Dual Eligible

Medically Needy

TP-Eligible Exempt—Option to enroll in Standard Plan, unless elects to receive

Innovations/TBI waiver

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 45

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 46

• Wipro Infocrossing

− Contracted vendor effective 12/31/2018

− Medversant

• Is a third party vendor of Wipro

• NCQA certified organization conducting the primary source

verifications

46

Vendor – PDC Vendor Information

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 47 47

Vendor – PDC Vendor Information

• PDC responsible for obtaining the primary source-verified credentialing data

for NC Medicaid and NC Health Choice enrolled providers

• PDC is not permitted to reach out to providers to update the provider’s

information, though providers are encouraged to keep their credentialing file

up to date with NCTracks

• PDC must ensure that PHPs have access to information from a credentialing

process that is held to consistent, current standards, the credentialing data

will be primary source-verified using the standards of NCQA

• PHPs will be required to accept verified information from the PDC and will

not be permitted to require additional credentialing information from a

provider to make their quality determination

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 48

Neither the PDC nor the PHP can contact NC Medicaid Providers for any

missing information

48

Primary Source Verification Process

Individual Providers

Education and

Training (Highest level) Board

Certification (Current board

status)

Malpractice History/ Liability

Insurance (Past 5 years)

Work History

(Past 5 years)

DEA/CDS Certification

Licensure

State Licensing

Board Sanctions (Past 5 years)

Medicare/ Medicaid Sanctions (Past 5 years)

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 49 49

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 50 50

Support – Call Center, Reports, & Training

Call Center Support

Toll-free Telephone Number

• Inquire about data provided by PDC

• Correct data provided by PDC

Training

• PDC will provide technical support and

training to PHP to ensure − successful implementation and operation of

the data exchanges

− online screens

− other functions as required within this

contract

• PDC will educate providers on process

to: − Correct data provided by the PDC

− Supplement information provided by PDC

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 51

Additional information:

https://www.ncdhhs.gov/assistance/medicaid-transformation

NCDHHS Division of Health Benefits | North Carolina’s LTSS Landscape | 3/19/2019 52

Questions & Comments

Thank you for your time and attention.

Question and Answer Session

BREAK

Leading Today, Empowering Tomorrow

Electronic Visit Verification Presented by: Cassandra McFadden, Program Operations Manager, NC Medicaid

NCDHHS, Division | Presentation Title | Presentation Date 56

NC Department of Health and Human

Services

Electronic Visit Verification (EVV) Overview

Cassandra McFadden, Program

Operations Manager

PCS Regional Trainings - May 2019

NCDHHS, Division | Presentation Title | Presentation Date 57

Overview – 21st Century CURES Act

• The CURES Act is designed to improve the

quality of care provided to individuals through

further research, enhancing quality control, and

strengthening mental health parity.

• Section 12006 of the CURES Act requires states

to implement an electronic visit verification (EVV)

system for Personal Care Services (PCS) by Jan.

1, 2020 & for Home Health Care Services (HHCS)

by Jan. 1, 2023.

NCDHHS, Division | Presentation Title | Presentation Date 58

What is EVV?

• EVV is a method used to verify visit

activity for services delivered as a part of

Home and Community Based Services

(HCBS) programs.

• EVV offers a measure of accountability to

help ensure that individuals who are

authorized to receive services, receive

them.

NCDHHS, Division | Presentation Title | Presentation Date 59

Services to be included in EVV:

• Phase 1—Target Jan. 1, 2020

− 1905(a)(24) State Plan Personal Care Services benefit **

− 1915(c) HCBS Waivers **

− 1915(i) HCBS State Plan Option

− 1915(j) Self-directed Personal Attendant Care Services

− 1915(k) Community First Choice State Plan Option

− 1115 Demonstration Waiver

• Phase 2—Target Jan. 1, 2023

− 1905(a)(7) State Plan Home Health Services

− Home Health Services authorized under a waiver of the

plan

**NC administers PCS under these authorities.

NCDHHS, Division | Presentation Title | Presentation Date 60

EVV Must Verify

Date of Service

Location of Service

Beneficiary Receiving Service

Person

Providing Service

Type of Service Rendered

Time the service begins and ends

NCDHHS, Division | Presentation Title | Presentation Date 61

Systems utilize a variety of technologies.

MEDICAID SAMPLE PRES | MONTH DAY, YYYY | V2 61

EVV Technology

NCDHHS, Division | Presentation Title | Presentation Date 62

NC Plans to utilize the Open Vendor Model

Definition

− States contract with a single EVV Vendor or build their own

system, but allow providers and MCO’s to use other vendors.

MEDICAID SAMPLE PRES | MONTH DAY, YYYY | V2 62

EVV Design Model

NCDHHS, Division | Presentation Title | Presentation Date 63

EVV’s Impact on Beneficiaries

• No significant disruption of services to

beneficiaries.

• Beneficiaries will be able to keep current

providers and caregivers provided they comply

with the EVV requirement.

• An EVV system does NOT change the services

provided, the provider selection, constrain the

individual’s choice of caregiver, or impede the way

care is delivered.

• EVV will be a valuable tool in managing the

accuracy and reporting of all services.

NCDHHS, Division | Presentation Title | Presentation Date 64

EVV’s Impact on Providers

• Reduce the likelihood of error or fraud by

recording an individual aide’s activity in real

time.

• Increase efficiency because reporting is

automated and may improve the claims

submission process.

• Improve quality of care by ensuring that aide

activities are transparent and measurable.

NCDHHS, Division | Presentation Title | Presentation Date 65

NC’s Progress towards Implementation

• Stakeholder Engagement

• Market Research – (Vendor Demonstrations, Consultation

with other States)

• EVV Utilization Survey- Issued February 28, 2018.

https://www.surveymonkey.com/r/FTR3J7J

• Implementation of EVV email address and webpage

Medicaid.EVV@dhhs.nc.gov

https://medicaid.ncdhhs.gov/electronic-visit-verification

• Request for Information (RFI)

NCDHHS, Division | Presentation Title | Presentation Date 66

Next Steps

• Continued EVV Workgroup sessions and

stakeholder engagement.

• Review of RFI responses to inform system design

• EVV System Procurement

NCDHHS, Division | Presentation Title | Presentation Date 67

QUESTIONS AND COMMENTS

Provider Portal Enhancements

Presented by: Emonique-Wooten Whitfield, Business Analyst, VieBridge, Inc.

QiRePort Provider Interface Enhancements

PCS Provider Training

May 2019

System Enhancements Implemented

• Online Service Plan Calendar/Hours – (In-Home Providers Only)

• Independent Assessment Pullback Notification

• NC Medicaid 3136 (Internal Quality Improvement Attestation) Form

Processing

• NC Medicaid 3085 (PCS Training Attestation) Form Processing

Online Service Plan Calendar/Hours In-Home Providers ONLY

• Online service plans must be marked complete to view the hours

comparison.

• The monthly authorized hours will display when the “Compare Plan

Monthly Hours to Authorized Monthly Hours” hyperlink is selected.

• Providers can use the table to determine which month(s), if any, to

modify aide schedules to prevent exceeding the authorized hours.

QiRePort will use the authorized Monthly Hours and Weekly Hours to determine

the “Plan Monthly” hours based on the “typical week” entered on the plan.

Select the “Compare Plan Monthly Hours to Authorized Monthly Hours”

hyperlink to view the comparison for the full authorization period.

The Over/Under column will show the number of hours to adjust each month, if needed

Independent Assessment Pullback

Notification

• PCS Providers will contact the Independent Assessment Entity

(IAE) if issues are found with an independent assessment or

service plan where correction is needed.

• If a rollback is warranted, the IAE will pull the assessment back to

the nurse assessor for correction.

• QiRePort will notify the provider of an assessment that is sent back

to the IAE for correction.

Referrals for Review

The beneficiary is listed with the

notification type

“Assessment Pulled Back for

Reprocessing”

• Select the Name hyperlink to view the informational (pop-up) message explaining the

assessment pull back. Once acknowledged, the notification is moved to the Accepted

(last 1 year) listing.

• Select the [letter] hyperlink to view the “Notice of Personal Care Assessment Correction”

notification.

NC Medicaid 3136 Form Processing Internal Quality Improvement Program Attestation

• PCS Policy 3L requires providers to submit by December 31st of

each year an attestation to NC Medicaid that they are in

compliance with the established Internal Quality Improvement

Program.

• QiRePort now allows providers to upload the NC Medicaid 3136

form into the system via the provider interface.

• Provider administrative users are allowed to upload forms.

• NC Medicaid and the IAE will have access to forms completed and

uploaded by each provider.

NC Medicaid 3085 Form Processing PCS Training Attestation

• In accordance to Session Law 2013-306; Providers serving beneficiaries seeking additional hours of PCS due to Alzheimer’s, or other Memory Care complications are required to have caregivers with training or experience in caring for these individuals.

• NC Medicaid requires PCS providers to attest to their aide training curriculum by submitting the NC Medicaid 3085 form.

• QiRePort now allows providers to upload the NC Medicaid 3085 form into the system via the provider interface.

• Provider administrative users are allowed to upload forms

• NC Medicaid and the IAE will have access to forms completed and uploaded by each provider.

Setup Menu

A “Documents” hyperlink has

been added to the left index menu

Select the “Provider Name”

hyperlink to access the “Provider

Info” screen for uploading

documents

Uploading Forms

Provider Info

• Provides the option to “Add

Document” to upload forms

Upload Record

• Provides the ability to select the

saved form to upload

Provider Documents

Uploaded documents are saved to the “Provider Documents” table. Note: If a form is uploaded in error, select the [edit] hyperlink to remove the form. Once the removal is

saved, the uploaded form is immediately removed and no longer accessible.

Need Assistance?

• Website Help – Ask a Question from the QiRePort Home Page

• Type in your question and send

• Reminder: Do NOT include PHI

• Training Resources

• Online Instructions

• Training Videos/Webinars

• QiRePort Support Center

• 1-888-705-0970

Questions?

Liberty Healthcare PCS Provider Training May 2019

Leading Today, Empowering Tomorrow

Thank you &

Safe Travels!