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Long Term Care (LTC) Provider Training. Revised 11/17/08. 1. HISTORY OF NETSPAP. N on- E mergency T ransportation S ervices P rior A pproval P rogram — NETSPAP Implemented in Cook County in June of 2001. Except for LTC residents, NETSPAP went Statewide in May of 2004.

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HISTORY OF NETSPAP

Non-Emergency Transportation Services Prior Approval Program— NETSPAP

  • Implemented in Cook County in June of 2001.

  • Except for LTC residents, NETSPAP went Statewide in May of 2004.

  • LTC resident population last phase-in.

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HISTORY OF NETSPAP

  • HFS must ensure that reimbursement of non-emergency transportation meets federal guidelines.

  • NETSPAP allows HFS to maintain standards and controls necessary to comply with federal requirements.

  • Effective mechanism in preventing fraud and abuse.

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TRAINING OBJECTIVE

To inform Long Term Care (LTC) Providers about prior approval policies and procedures for non-emergency transportation.

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INTRODUCTIONWho is First Transit?

  • First Transit administers the Non-Emergency Transportation Services Prior Approval Program (NETSPAP) for the Department of Healthcare and Family Services (HFS).

  • In performing this function, First Transit follows HFS’ policies for non-emergency transportation.

  • First Transit does not provide or arrange transportation services for HFS participants.

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Non-emergency vs. Emergency Transportation

  • All non-emergency transportation requires prior authorization by First Transit.

  • Emergency transportation does not require authorization by First Transit.

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“Prior Approval” Defined

  • Beginning September 17th, for dates of service on or after October 1, 2007, non-emergency services for residents of Long Term Care (LTC) Facilities will require prior approval.

  • “Prior Approval” means that the trip must be authorized BEFORE the Non-Emergency Transportation (NET) Provider transports the participant to their medical appointment. (Prior approval should be obtained at least 2 to 3 business days before the appointment)

  • If prior approval is not obtained, the NET Provider will not be paid for their service.

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Non-emergency transportationwill be authorized if:

  • The participant has an appointment scheduled for a covered medical service, and

  • The participant is being transported to the closest appropriate medical provider, and

  • The Category of Service being requested is at the appropriate levelnecessary to meet the participant’s medical needsi.e. service car and medicar.

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EXAMPLES OFCovered Medical Services

  • Doctor appointments

  • Hospital admission or discharge

  • X-rays, lab work, MRI, etc

  • Chiropractic care

  • Renal dialysis, physical therapy, chemotherapy, radiation services

  • Behavioral health services

  • Outpatient surgery

  • Dental appointments

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EXAMPLES OFServices that are NOT Covered

  • Acupuncture

  • Prescription pick-up

  • SSI evaluations

  • Wheelchair repair or pick-up

  • Methadone pick-up or treatment

  • Smoking cessation

  • Day Treatment Programs

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LTC Providers may request single trip transportation services and standing prior approval trips for their residents.

On October 5, 2007, a new standing prior approval policy was implemented by HFS. In the new policy, Standing Prior Approvals (SPAs) can be requested by anyone, including the LTC Provider.

How can LTC Providers obtain prior

approval from First Transit?

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STEP ONE: services and standing prior approval trips for their residents.Gather all required information

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Prior to Contacting First Transit, services and standing prior approval trips for their residents.the LTC Provider needs the following info:

  • The participant’s Recipient Identification Number (RIN)

  • The participant’s date of birth

  • Date and time of the medical appointment

  • Information about the medical appointment (i.e. the type of services that the participant will receive)

  • Information about the medical provider (i.e. the correctly spelled doctor’s name or facility, the medical provider address, the most direct telephone number, etc.)

  • Information for the Transportation Screening (i.e. Is the participant able to step into a regular car? Are they wheelchair bound?, etc.)

  • The participant’s appropriate Category of Service (i.e. service car, medicar, non-emergency ambulance)

  • The preferred NET Provider

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STEP TWO: services and standing prior approval trips for their residents.Contact First Transit

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There are three ways to request prior approval from First Transit

  • First Transit’s Online System - passPORT

  • Fax or Mail

  • Telephone

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FIRST TRANSIT’s TransitOnline System: passPORT

BEST WAY TO REQUEST TRANSPORTATION

Service is available 24 hours a day, with no limitation on inquiries

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FIRST TRANSIT’s TransitFax Numbers(312) 327-3854 or (312) 327-3855

Fax machines are operational Monday through Friday

8:00 a.m. – 5:00 p.m.

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FIRST TRANSIT’s TransitProvider Toll-Free Number(866) 503-9040

Operators are available Monday through Friday

8:00 a.m. – 5:00 p.m.

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IMPORTANT TransitTo Remember

  • Whether requesting prior approval through passPORT, by phone, fax or mail, the LTC Provider must give ALL INFORMATION requested on the NETSPAP Single Trip Form or by the Customer Service Representative.

  • All forms submitted to First Transit must be complete, accurate and legible. Incomplete forms will be returned.

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STEP THREE: TransitWait for First Transit’s Decision

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Waiting for First Transit’s Decision Transit

  • Routine requests are usually processed within 2 business days.

  • Non-routine requests may take up to 5 business days to process. Some medical services must be validated by the Transportation Review Unit (TRU) in order for First Transit to determine whether the request for transportation is approvable or not.

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EXAMPLES Transitof Non-Routine Requests

  • Transport by non-emergency ambulance (prior and post approval)

  • Behavioral Health Services

  • Standing Prior Approval (SPA) Overrides

  • Long Distance Trips

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Notification from First Transit Transit

  • Participants will receive denial letters.

  • Participants will receive approval letters for standing prior approvals.

  • NET Providers will receive both approval and denial letters.

  • LTC Providers enrolled in passPORT have access to faster notifications online.

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STEP FOUR: TransitLTC ProviderCoordinates the Participant’s Transportation

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Coordinating the Participant’s Transportation Transit

If First Transit approves the request:

  • The LTC Provider contacts the NET Provider to schedule the trip. NET Provider will need the approved Request Tracking Number [RTN]. (HFS pays the NET Provider through the RTN)

  • The participant’s pick-up and drop-off times must be arranged with NET Provider.

  • First Transit will make every attempt to accommodate existing relationships with NET Providers.

  • If the LTC Provider is also enrolled as a NET Provider, prior approval must be obtained from First Transit, for trips to be eligible for payment from HFS.

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Coordinating the Participant’s Transportation Transit

If First Transit denies the request:

  • HFS will not pay for the transportation.

  • Alternate transportation must be arranged for the participant.

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Common Denial Reasons Transit

  • Medical service is not covered by HFS.

  • Participant is not eligible for transportation on date of service.

  • Post Approval was requested too late.

  • Unable to validate medical appointment.

  • Additional information requested was not received timely.

  • Closest appropriate medical provider is not being used.

  • Participant refuses to use the appropriate Category of Service.

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SINGLE TRIP FORM TransitHas 6 Main Sections

  • Requesting organization information.

  • Participant information.

  • Trip information.

  • NET Provider information.

  • Category of Service.

  • Signature of requesting person.

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SINGLE TRIP FORM Transit

Identify the type of Long Term Care Facility on the Form

For example: if the resident belongs to a nursing home, check ‘Resident of Nursing Facility (NF)

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SINGLE TRIP FORM Transit

Reason for Trip Must Be Specific

For example: doctor appointment, dialysis treatment, etc. Trips for hospital admits or discharges must include the reason for the participant’s hospital admission

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SINGLE TRIP FORM TransitNET Provider Information

  • All transportation requests must include a NET Provider that has confirmed that they will transport the participant.

  • Pick-up and drop-off times must be prearranged with the NET Provider.

  • If the participant does not have a preferred NET Provider, First Transit can provide information on enrolled transportation companies from a random selection process.

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SINGLE TRIP FORM TransitCategory of Service

The Category of Service must be the MOST ECONOMICALLY FEASIBLE TRANSPORTATION able to meet the participant’s medical needs.

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Categories of Service Transit

  • Private Automobile

  • Service Car or Taxi

  • Medicar

  • Non-emergency Ambulance

    Other Assistance

    Non-employee attendant

    Employee attendant

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Categories of Service TransitDEFINED

  • Private Automobile/Service Car/Taxicab – Transportation by passenger vehicle of a patient whose medical condition does not require a specialized mode.

  • Medicar– Transportation of a patient whose medical condition requires the use of a hydraulic or electric lift or ramp, wheelchair lockdowns, or transportation by stretcher when the patient’s condition does not require medical supervision, medical equipment, the administration of drugs or the administration of oxygen.

  • Non-emergency Ambulance – Transportation of a patient whose medical condition requires transfer by stretcher and medical supervision. The patient’s condition may also require medical equipment or the administration of drugs or oxygen, etc. during transport.

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TYPES OF NON-EMERGENCY AMBULANCES Transit

  • Basic Life Support (BLS) Ambulance - provides transportation plus the equipment and staff for basic services such as giving first aid, controlling bleeding, administering oxygen, treatment of shock, taking vital signs or administering cardiac pulmonary resuscitation (CPR).

  • Advanced Life Support (ALS) Ambulance - provides all basic ambulance services and typically has complex life-sustaining equipment and radio or telephone contact with a physician or hospital.

    Note: Certification of medical need is required for BLS and ALS transports.

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OTHER ASSISTANCE TransitATTENDANTS

When medically necessary, a person can accompany participants in service cars, taxi cabs, and medicars

  • Non-employee Attendant – a family member or other individual who may accompany the participant when there is a medical need for an attendant.

    Examples of non-employee attendant include LTC employee assisting a participant in a wheelchair, family member or friend accompanying a participant with mental impairment.

  • Employee Attendant – a person, other than the driver, who is an employee of a transportation company.

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EXAMPLE TransitTo obtain prior approval for Melvine

You need to gather the following information:

  • RIN 111111111

  • Podiatry appointment on October 9, 2007 at 9:00 a.m. with Dr. John Ross.

  • The appointment is at the Foot Clinic at 111 N. First Street, in Chicago, IL 60015.

  • She is able to step into a regular car.

  • She does not use a wheelchair, walker, or cane.

  • She needs someone to travel with her due to her Alzheimer's condition.

  • She travels with A & B Transportation at 312-741-5555.

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FIRST TRANSIT’S TransitNETSPAPSingle Trip Form

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EXAMPLE TransitTo obtain prior approval for Melvine

You could submit the NETSPAP Single Trip Form through passPORT, fax or mail. You could also call First Transit.

If approved you would contact A & B Transportation to coordinate Melvine’s transportation.

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Q & A Transit

Question and Answer Session

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passPORT Transit

First Transit’s On-Line System

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FIRST TRANSIT’s TransitOnline System’s

passPORT’s Features

  • LTC Providers may submit Single Trip requests.

  • LTC Providers may access trip information through the request tracking number.

  • LTC Providers can receive authorization information.

  • LTC Providers do not have to wait to receive paper authorization through the mail.

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LOGGING INTO passPORT Transit Enter User Name and Password

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LOGGING INTO passPORT TransitRequesting a user name.

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FIRST TRANSIT’s Trip FormOnline System’s

passPORT Advantages

  • Available 24 hours a day – 7 days a week.

  • Unlimited inquiries and transactions.

  • Easy to organize and access participant information.

  • More efficient time management - no waiting to talk to a Customer Service Representative.

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Q & A Trip Form

Question and Answer Session

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