PA Adjustment Training

1. PA Adjustment Training

2. How to complete a PA Adjustment • First you will need the PA number, the Member ID number which is the client’s Medicaid number, and the start date for the PA you wish to be adjusted. • Next you will need to select the PA Adjustment Tab (located under CDC Search in PICIS)

3. Select Add New if you’re submitting a new PA adjustment request. • If you’re searching for a previously submitted adjustment request or checking the status of a submitted adjustment request, enter the member ID or PA number and select search.

4. After selecting Add New, you will be in the PA Adjustment Request Screen..

5. Insert your Contact information, your name, your email, your phone (not the customers). Insert your Contact information, your name, your email, your phone.

6. Insert the client’s member ID or Medicaid number in the recipient ID field and then the PA number needing changed in the PA number field.

7. PA Adjustment Request Types

8. Request Types • Exceptional Case (Health Home only): A request to be enrolled into Health Home for individuals 0-47 months of age, who could benefit from health home services and meets all medical necessity criteria. • Rehab: A PA adjustment request may be submitted for rehabilitation services when a provider is seeing a client for psychotherapy services, there is a defined need for behavioral health rehabilitation services to compliment these more intensive therapies, and all Medical Necessity Criteria for this level of service are met.

9. Types of Request Types (cont.) • Correct Authorization: A request for PA Adjustment may be submitted when a provider finds any errors or discrepancies on a PA and needs the PA deleted, when the PA needs backdated, or when submitting for additional cm units when the client has been inpatient within the last five years. • Be sure before doing a Correct Authorization that you have not billed on the prior PA for the dates that you are needing corrected, if so you will need to void those claims out. • Also, you can’t have a PA deleted if paid claims have not been voided.

10. Request Type 1: Exceptional Case for Health Homes • A narrative justification summary is required in the text field on the electronic request in PICIS. The narrative summary response should address the following: • Documented support of the need for the intensive Wraparound and Care Coordination services that are provided within a Health Home program. • The following documents are required to be uploaded and attached to the electronic PA Adjustment Request: • Survey of Well-being for Young Children (SWYC) : • For a child under 18 months of age, the child must meet the following criteria on the Baby Pediatric Symptom Checklist -Any summed score of 3 or more on any of the three subscales indicating that a child is “at risk” and needs further evaluation or investigation. • For a child between the ages of 18 – 47 months, the child must meet the following criteria on the Preschool Pediatric Symptom Checklist - A PPSC total score of 9 or greater indicating that a child is "at risk" and needs further evaluation or investigation • And Parent’s Observations of Social Interactions with a result of three or more points in the last three columns indicating that a child is “at risk” and needs further evaluation or investigation. • Clinical Assessment including: • Bio‐psychosocial assessment, including a narrative of any updates if the assessment was not completed in the last 30 days (the updated information provided in the descriptors for the current CAR assessment may provide sufficient update): should include DC: 0-5 primary diagnosis that can crosswalk to DSM 5, Axis 1

11. The Start Date is the start date of the current outpatient PA. • To attach the documents • Select browse, find the document, and then click attach This is what it looks like after you have attached a document.

12. Request Type 2: Rehab (for agencies only) • When completing a PA adjustment request for rehabilitation services, select the request type based on how the client meets the medical necessity criteria for services, for example Rehab for Ages 4 & 5. • Each rehab criteria has different submission and documentation requirements • For more details regarding rehab PA adjustments and documentation, see the links below: • Rehab criteria: http://www.odmhsas.org/picis/Documents/Eligibility/Rehab%20Eligibility%20Rule%20Changes.pdf • PA manual: http://www.odmhsas.org/picis/Documents/Manuals/FY2019_ODMHSAS_Services_Manual.pdf

13. To attach any required documentation • Click browse, find the document, and then click attach

14. Request Type 3: Correct Authorization • This Request type is for any other adjustments that need to be made to the PA • Date correction or backdating • Removal/deletion of a PA • Additional CM units (inpatient only)

15. Date Correction • For the Start Date indicate the date you need the PA to start and give a brief explanation. • For all other corrections indicate the start date for the PA and give a brief explanation of what correction/s needs to be done.

16. Contact Information • PICIS HelpDesk • 405-248-9326 • gethelp@odmhsas.org • http://ok.gov/odmhsas/