Automated Peer Review Organization (PRO) Certifications. Cabinet for Health and Family Services – DCBS Training Branch – December 2009. PRO Certifications. PRO Certifications are used to verify the admission date and date “level of care” is met for a Long Term Care or Waiver recipient.
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Cabinet for Health and Family Services – DCBS Training Branch – December 2009
The following information is found on KAMES inquiry, including:
Use verification source of “PR” on the LTC screen on KAMES for the following types of care:
There are 3 ways to search for your client’s confirmation notice on KAMES!
The following slides demonstrate these options...
Option “P” in KAMES inquiry allows workers to search for confirmation notices.
This screen allows the worker 3 ways to search for the PRO Certification on KAMES.
When option Certification on KAMES.A is selected, the worker may search for client information using their SSN.
Enter the SSN, then press Enter...
Results for the SSN entered are shown on this screen. Certification on KAMES.
The worker would then select the corresponding line number and press Enter to access the certification.
Enter the line number corresponding with your client’s information. In this example, we are using line # 8.
“ information. In this example, we are using line # 8. Date Received”- This is when the certification was received.
“Initial”- Tells the worker if this is the first certification for this client. If NOT, the worker must find the initial certification to ensure the client is given the correct Medicaid effective date.
Also, the provider name, type, and number are shown.
The “ information. In this example, we are using line # 8. date level of care met” and “admission date” are at the bottom of the PRO Certification screen, shown here.
The second search option is to search for client info by entering either client name or facility provider number or you can enter both facility provider number and client name, to narrow your search.
Here, KAMES shows matches for a search where entering both provider number and client’s name were entered.
We would then choose the line number which corresponds with our client’s info to obtain the certification verification.
The third search option on KAMES allows workers to search using county number and date range (the date KAMES received the confirmation record).
This search option matches all PRO certifications which were completed for that county in that specific date range.
Thank you for utilizing this learning session. We hope you found it helpful.
Comments or suggestions regarding this training product should be directed to:
Cabinet for Health and Family Services
DCBS Training Branch - December 2009