1 / 35

Report to the Operations Sub-Committee October 6, 2006

Report to the Operations Sub-Committee October 6, 2006. Network Operations. Web Registration. Security Access/User ID Requests 1,743 User Id’s generated as of 9/29/06 7 Requests currently in process Security Access – No Response 498 EDS/Medicaid Providers

tan
Download Presentation

Report to the Operations Sub-Committee October 6, 2006

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Report to the Operations Sub-Committee October 6, 2006

  2. Network Operations

  3. Web Registration • Security Access/User ID Requests • 1,743 User Id’s generated as of 9/29/06 • 7 Requests currently in process • Security Access – No Response • 498 EDS/Medicaid Providers • Provider Alerts sent to those 498 providers on 9/19/06 • Mailing included Provider Alert, Security Access Form and Registration FAQ’s.

  4. Web Registration - Totals Completed Web Registrations as of 9/29/06 Outpatient Services………………..12,646 Methadone Maintenance…………..1,076 Ambulatory Detoxification……………. 28 Family Support Team…………………104 (Home Based Service)

  5. Web Registration Continued • 13,829 - Registrations completed since August 1, 2006 • Average time per registration: 2.5 – 3 minutes • Registration has been extended for an additional 61 days. • Providers have until October 31, 2006 to enter Web-Registrations for September 1, 2006 and forward dates of service. • The 21 day retro-registration limit will begin November 1, 2006 • All fields for web registration will be required November 1, 2006. • Provider Alert scheduled for release on October 6th • Winfax Registration Forms • 45 Requests as of September 29, 2006

  6. Network Status • 64 Hospitals (includes CAA, state, general & free standing) • 323 Clinics (includes hospital based, methadone, MH clinics, FQHC’s, Medical clinics & rehab clinics) • 39 ADAC Inpatient, Rehab and Outpatient 426 Facilities and Clinics

  7. Network Status, continued • 335 Psychiatrists • 102 Nurse Practioners • 274 Psychologist • 620 LCSW, LMFT, LADC, LPC 1331 Individual/Group Practioners

  8. September 12, 2006 434 – PA Number Invalid 139 – PA Services Exhausted 37 – Procedure has not been Prior Authorized 164 – Dates of Service Not Within Authorization Effective Dates 138 – Procedure Requires Prior Authorization September 25, 2006 244 – PA Number Invalid 101 – PA Services Exhausted 180 - Procedure has not been Prior Authorized 474 – Dates of Service Not Within Authorization Effective Dates 1,892 – Procedure Requires Prior Authorization (the majority related to outpatient) Rapid Response Team

  9. Provider Authorization Issues • Follow up with providers since last sub-committee meeting - themes uncovered, reviewed and support given • Inpatient programs had difficulty correctly billing June/July crossover • Lack of PA for PHP and IOP programs • Issues related to clinician data entry errors • One provider who had articulated concerns saw claims denied drop from 28% in July to 8% in August • Length of review: 17 minutes for pre-cert

  10. CPT Transition • Tracking forms finalized • IT infrastructure under construction • Training with John Lyons, PhD scheduled for October 23, 2006 • Provider file information to be updated/verified October, 2006 • Anticipated transition 11/1/06

  11. Utilization Management

  12. Members who Access 24 hour Care by LOCSeptember 2006 ADR/IPD: Inpatient detox/rehabilitation GHA/GHC Group home 1.0/2.0 IPF: Inpatient Psychiatric Facility PRTF: Psychiatric Residential Tx Facility RTC: Residential Treatment Facility

  13. Authorization and Concurrent Review UpdateSeptember , 2006

  14. Inpatient/PRTF Discharge Delay Status September, 2006 • 17% of children in an Acute Inpatient setting are defined as Discharge Delay • 50% are awaiting placement in Residential and/or PRTF • 10% are awaiting Community Services • 17% are awaiting Group Home placement • 17% are awaiting Placement: other or unspecified • Average length of stay in Delayed status is 50 days • Discharge Delay information from resi continues to be “scrubbed” for accuracy ~ Out of State placements being reviewed • Care Management training of appropriate identification of delay status continues

  15. ED Delayed Discharge Activity • All ED’s being contacted daily, resulting in increased case identification and coordinated discharge planning • Overview: • May: 6 cases, average LOS 3.5 days • June: 5 cases, average LOS 7.2 days (1 outlier) • July: 10 cases, average LOS 2.9 days • August: 11 cases, average LOS 1.1 days • September: 26 cases, average LOS 2.0 days

  16. ED Delay Tracking: September 2006

  17. ICM Referral Tracking

  18. ICM Activity • All “delayed status” members currently in inpatient settings are assigned (September: 30) • Coordinating Collateral meetings to determine barriers to appropriate disposition for acute levels of care • Attending MSS mtg’s with System Managers • Identifying cases from daily census reports in MSS mtg’s in order to facilitate appropriate treatment planning • Contacting ED’s and Area offices for updates on a daily basis • Working with Systems Managers to coordinate meetings with each Hospital ED in Connecticut • Monthly MCO meetings/trainings including reviews of co-medically managed cases

  19. Customer Service/Call Center Activity

  20. 2006 Call Volume YTD

  21. Calls answered in < 30 seconds YTD

  22. CT BHP CALL MANAGEMENTIncoming Calls Totals: September, 2006 Total 5220

  23. Types of InquiriesSeptember, 2006 43% - Provider Referrals for Members 27% - Member Eligibility Verification 21% - Provider Related/Authorization/Enrollment/Billing 9% - General Information52% = Member Inquiries

  24. Quality Management

  25. Complaints

  26. Complaint Reason Codes2006

  27. Number of Complaints Per 1000 Members

  28. Grievances

  29. Grievances 1/1/06 - 9/30/06

  30. Other Quality Initiatives • IRR with Clinical/Medical Affairs • Internal Chart Audit w/ Clinical/Peer Support Departments • Clinical Studies initiated • Provider and Member Satisfaction due December 1, 2006 • Mercer Post Implementation preparation • Data integrity analysis

  31. System’s Management

  32. System Management Update • Received final approval on the LADPs for Norwich, Willimantic and Waterbury • 6 additional LADPs due October 15, 2006 • 5 final LADPs due November 15, 2006 • Conducting ongoing community meetings to finalize and implement LADPs • Working closely with Emergency Room administration to address systems issues

  33. System Management continued • Finalized ASO/DCF Stuck Case Management flow chart for Emergency Departments – next step is review and training • Interface with Department of Education continues • Brochure for schools in final stages of development • Preparing next CT BHP Newsletter

  34. Community Interaction:Peer/Family Services

  35. September 2006 Peer Unit Statistics *Includes PPT Meetings **DCF Office or Riverview ***Family Organizations (FAVOR, AFCAMP, etc)

More Related