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Provider Certification Renewals

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  1. MDA Updates: Provider Certification Renewals & Medicaid Services System (MSS)Presented by: Tracy Cloud and Angel MorganJanuary 25, 2011

  2. Provider Certification Renewals O.A.C. Rule 5123:2-2-01 went into effect October 1, 2009. This rule was created in order to: Create renewal process in order to maintain most accurate and up-to-date list of providers while ensuring they maintain standards of certification.

  3. Overview of Renewals Topic 1: Who’s certification is being renewed Topic 2: What is required for renewal Topic 3: What happens to providers whose certification has lapsed?

  4. Who should be renewed? People certified prior to September 30, 2009 Expiration dates have not yet been assigned for majority of providers certified prior to 9/30/09 288 provider-test round sent out with expiration of 1/1/11 every provider to be assigned a date by 12/31/12 All renewals will be good for 3 years

  5. People certified on or after October 1, 2009 All initial applicants will be issued a 1-year certification term upon initial certification approval Following 1st renewal, certification will be good for 3 years 458 applications have been sent out with providers expiring October 2010 – April 2011 89 of these have renewed their certification Who should be renewed?

  6. Requirements for Renewals Independent Providers CERT-01a form (renewal certification form) Valid “American Red Cross” or equivalent certification in first aid Valid “American Red Cross” or equivalent certification in CPR Current BCII Certificate of training in MUI (incidents adversely affecting health and safety) Certificate of training in Client Rights Fee: $100

  7. Requirements for Renewals Agency Providers CERT-01a form (renewal certification form) Fee: $800 (Small Agency – 50 or fewer individuals); $1600 (Large Agency – 51 or more individuals)

  8. Expired Providers If renewal application is not received by expiration date: Providers cannot bill and cannot provide services during the time of their expired certification If application materials come in after the expiration date, there will be a gap in payment

  9. Expired Providers If renewal application is received by expiration date, but incomplete: Providers will not receive payment for any services provided unless completed application is received within 90 days of review of application If received within 90 days, provider can resubmit claims once approved If not received within 90 days, there will be a gap through the new receipt date

  10. Overview In today’s discussion, we covered: • Who’s certification is being renewed • What is required for renewal • What happens to expired providers

  11. Questions about Renewals?

  12. Thank you! If you have additional questions or concerns about the renewal process, please contact the Department of Developmental Disabilities at 1-800-617-6733, option 3.

  13. MSS Status • Full implementation: Dec 22nd • Phase 1 Training: Completed Dec 15th • 4518 sites have been created statewide. • 971 sites include finalized cost projections.

  14. MSS Reporting • MSS Reports: site specific data • Cost Projection Detail Report • HPC & ADS Staffing/Calendar Reports • Unscheduled vs. Scheduled HPC Report • Individual Tracking Report • Cognos Reports: county-wide data • Finalized Sites Report • HPC & ADS Staffing/Calendar Reports • Unscheduled Services Report • DRA utilization

  15. MSS & Prior Authorization • The Cost Projection Details shall be used in place of a PA budget. • Step 1: Create a cost projection that reflects the PA request and save a version. • Step 2: Write the name of the saved PA version on the Individual Request Form (IRF). • There is no need to submit a budget. PA staff have been trained to use MSS.

  16. MSS Work Plan • Short Term Priority Work: • Correcting defects • Technical assistance and support • Cognos report training • Implementing the new waiver services • Long Term Priority Work: • Enhances to improve usability • Implementation of Prior Auth System • Phase-out of PAWS

  17. MSS Support • Send an e-mail to: msssupport@dodd.ohio.gov • Call 1-800-617-6733, option 2 or option 4 for MSS access issues. • To contact an MSS Trainer or obtain training resources and FAQ’s: http://mrdd.ohio.gov/medicaid/medicaid.htm