blue plus care coordination 101 training · pdf file• hha: home health aide ......

Confidential and proprietary. Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.Confidential and proprietary.

BLUE PLUS COMMUNITY CARE COORDINATION 101

September 2017

Confidential and proprietary.

Common Acronyms

• BP: Blue Plus

• CC: Care Coordinator

• CCP: Collaborative Care Plan

• CW: Community Well

• EW: Elderly Waiver

• NH: Nursing Home

• DTR: Denial, Termination or Refusal

• HRA: Health Risk Assessment

• IHM: Integrated Health Management

• PCC: Primary Care Clinic

• PCNL: Primary Care Network Listing

• RA: Reassessment

• RS Tool: Residential Service Tool

• TOC: Transition of Care

• UM: Utilization Management

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• FFS: Fee for Service Medicaid

• SNV: Skilled Nurse Visit

• HHA: Home Health Aide

• PDN: Private Duty Nursing

• OT: Occupational Therapy

• PT: Physical Therapy

• RT: Respiratory Therapy

• ST: Speech Therapy

• PCA: Personal Care Attendant

• MSHO: Minnesota Senior Health

Options

• MSC+: Minnesota Senior Care Plus


Interdepartmental Communication

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Partner Relations

• Communiques, Communications, Guidelines updates

• Audits

• Trainings

• Quality Improvement Projects

Clinical Guides

• Member specific questions

• Preadmission Screening

• Out of state hospital coordination

Utilization Management

• Inpatient and discharge notification

• MA State Plan Service Authorizations

• Prior Authorizations

• Denial/Termination/Reduction

Bridgeview

• Elderly Waiver Service Agreements

• Assessment Entries

• Enrollment Reports

• Health Risk Assessment Audits

Confidential and proprietary. 4


Blue Plus 2017

Service Area

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Clinical Guides

The Clinical Guide Resource Team is available for member specific questions. Do not include PHI in email subject. Send secure emails to:

[email protected]

Examples:

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Case ConsultTransportation

AlternativesFormulary Questions

Out of state hospital

coordination

Blue Plus and Community Resources

Does not quote benefits


Partner Relations Communications

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• Formal communication for changes to:▪ Processes

▪ Contract Requirements

▪ Quality Improvement Projects

▪ Initiatives

• Saved on the Blue Plus Care Coordination Portal

Communiques

• General information regarding announcements, upcoming trainings, and messages targeted to a select group of delegate(s).

• Not saved on the Blue Plus Care Coordination PortalCommunications:

• Emails are sent from: [email protected] email box

• Delegates decide who they want receiving the emails

• Quarterly Blasts: review of information shared in the last quarter

How are they communicated?


Where is BP INFO Housed?

Access the BP CC Web Portal for the most updated information:

www.bluecrossmn.com/carecoordination

• CC Guidelines (updated 3 times per year)• 6.02.03 Medicare-Medicaid Member Rights (provide at initial and

reassessment)• Blue Plus Forms• Member Letters• Communiques• Communications• Trainings• Resources• Bridgeview Link

**Care Coordinators are responsible to read the guidelines.8

http://www.bluecrossmn.com/carecoordination


Care Coordination Delegates

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• Nursing Homes in select counties

• Catholic Charities

• Lutheran Social Services

• Thomas Allen Inc.

• Meridian Services

• BlueStone

• Essentia

• Fairview Partners

• HealthEast

• Genevive

• LRHC

• See resource 9.07 Care Coordination Delegate Listing and Contact Table on BP CC Web Portal

County Delegates Care

Systems

BCBS Internal

CC’s

Private Agencies


CC Identification Reminders

• All Delegates contracted to provide Care Coordination are extensions of Blue Plus

• Always identify yourself as the member’s Blue Plus Care Coordinator

• Email signatures: • First identify your primary agency’s name• Then identify your secondary role as Blue Plus Care

Coordinator

• Contacting member services to reach a live service rep:• Prompts- Identify yourself as member• Enter member Blue Plus ID (8+PMI) • Once rep comes on you can identify yourself as their BP CC

and provide the name of your agency

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SECUREBLUE MODEL OF CARE


The Model of Care (SNP-MOC)

• Required of all Special Needs Plans (SNPs)

• Goal of MOC: To simplify access to healthcare and reduce fragmentation of care delivery for our members.

• Submitted to CMS at least every 3 years• Describes staff, systems, procedures, and improvement

activities.

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The Model of Care (SNP-MOC)

• The SecureBlue population• Benefits and services• Staff roles and responsibilities across health plan

functions• Delivery of care coordination

• Health Risk Assessment, Collaborative Care Plan, Interdisciplinary Care Team, Transitions of Care

• Provider network• Measurable quality and performance improvement

goals• How care is coordinated and delivered

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The Model of CareCC Role and Responsibilities

Care Coordination delegates support the implementation of the SNP-MOC by:

• Following the policies and procedures contained in the Blue Plus SecureBlue Care Coordination Delegate Guidelines

• Complying with all DHS requirements and CMS rules and regulations related to the timely completion of the initial HRA and annual reassessment

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The Model of Care CC Role & Responsibilities

• Ensure communication between members of the Interdisciplinary Care Team

• Conduct Health Risk Assessment (HRA): • Identify member’s medical, functional, cognitive, psychosocial, and mental

health needs

• Develop person-centered Collaborative Care Plan: • Address the needs identified in the HRA

• Connect members to resources, care, and services

• Support smooth care transitions between care settings

• Monitor and document progress toward health goals and changes in health status

• Deliver targeted education about care coordination to providers

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SNP-MOC Training Requirement

CMS requires that all Care Coordinators complete SNP-MOC training upon initial hire and annually thereafter:

• Blue Plus utilizes the annual Fall Care Coordinator Training to fulfill this requirement

• All newly hired Care Coordinators must review the current Fall training slides and sign the attendance sheet. Keep on record with your agency

• Delegates are responsible to ensure that any Care Coordinator who did not attend in person receives and reviews Fall Training slides

• Delegates must collect attestations from all care coordination staff confirming completion of the required SNP-MOC training (i.e. sign in sheet)

**See Care Coordination Guidelines for additional details16


SecureBlue vs. MSC+ Comparison

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SecureBlue (MSHO) MSC+ with separate Medicare

and Part D plans ✓ One phone number serves all types of questions

▪ Up to three member service numbers: MSC+, Medicare and

Part D

✓ One set of materials covering all benefits ▪ One set of materials for MSC+ benefits

▪ One set of materials for Medicare benefits

▪ One set of materials for Part D benefits

✓ One card for Medicaid and Medicare medical, dental and

prescription drug coverage

▪ One MSC+ card.

▪ Additional cards if enrolled in Medicare and Part D prescription

drug plans.

✓ Reduced paperwork from one health plan that handles

all benefits and pays most bills

▪ Potential paperwork from each benefit plan. Member ultimately

responsible for working out which plan should pay bills

✓ No three day qualifying hospital stay is required prior

to receiving Medicare covered skilled services in a nursing

home.

▪ Three day hospital stay is required prior to receiving Medicare

covered skilled services in a nursing home.

✓ Additional benefits at no charge▪ No additional benefits

✓ Additional 90 days of Medicare coverage for enrolled

members who lose Medicaid coverage.

▪ Coverage ends the date Medicaid coverage terms

Current MSC+ members may want to consider enrolling in SecureBlue for its additional benefits and streamlined plan design:


Product Discussion

As a Blue Plus CC you are responsible for:• Reviewing MSHO benefits and enrollment with MSC+ members,

if applicable

• Discussing available supplemental benefits with current MSHO members

• Document discussions in case notes

MSHO Resources available on the Care Coordination Web Portal:

https://www.bluecrossmn.com/carecoordination/public/msho_index.html

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https://www.bluecrossmn.com/carecoordination/public/msho_index.html


MSHO Referrals

Care Coordinators can refer eligible MSC+ members:

Send a secure notification request to Stacy Rogers at [email protected] with the following information:

• Name of Delegate making request

• Members Name

• Date of birth

• Preferred contact number

• Mailing Address

• Primary clinic

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Confidential and proprietary. 20


ANCILLARY SERVICES

*Provider network is subject to change


BlueRide Medical Transportation

• Medical appointments are defined as: dental, doctor, psychiatry, and psychology appointments

• Common carrier and special transportation vendors available

• Requests should be made 3 days prior to the medical appointment, either by using the BlueRide Portal or calling into BlueRide

• Requests made less than the 3 days must be called into BlueRide

• Same day ride requests available after hours, on weekends and holidays for ER and hospital discharges.

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Medical Transportation

How to schedule medical rides:

• BlueRide Portal for Care Coordinators (preferred):

https://www.bluecrossmn.com/blueride/

OR

• Contact BlueRide:

1‐866‐340‐8648 or 651‐662‐8648

BlueRide operation hours 7 am- 5 pm Monday-Friday.

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Delta Dental

Delta Dental Process:• Member contacts Delta Dental• Delta Dental provides 3-5 Providers accepting Blue Plus• Member contacts the 3-5 Providers

If the member is unsuccessful after calling the Providers, member will call Delta Dental and the Delta Dental Coordinator will schedule the appointment and warm transfer to BlueRide, if needed.

Member: 651-406-5907 or 1-800-774-9049Care Coordinator: 651-994-5198 or 1-866-303-8138

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Interpreter Services

Via Language (telephonic)❖Call: 1-800-225-5254

❖Caller must have:➢ BCBS Care Coordinator “customer code”

➢ Cost center

Contact your Partner Relation Consultant for code and cost center

Face to Face: Contact one of the contracted interpreter agencies directly:

❖The Bridge (320) 259-9239

❖Itasca Interpretation Services (651) 457-7400

❖Midwest Language Banc (612) 588-9410

❖Arch Language Network, Inc (651) 789-7897

If you experience issues, send a secure email to: [email protected].

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mailto:[email protected]


ENROLLMENT


Enrollment Reports

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New Cap

• Sent by the 5th of each month

• Lists new members

• Occasionally report is available prior to the enrollment month. Do not start care coordination activities until on or after the 1st of the enrollment month.

Full Detail

• Sent by the 10th of the enrollment month

• Comprehensive list of active members

• Includes specific flags, see next slide for terminology

Daily Add

• Late enrollment(s) from DHS after New Cap and Full Detail reports are processed

• Retroactively assigned members:• NEW

• REINSTATED


Full Detail Enrollment Report

Includes the following flags:

• NEW: New enrollees

• REINSTATED: Members who were going to term but were reinstated with no lapse in coverage

• TERMED: Coverage termed

• TERMED FUTURE: MA will term at the end of the month (often related to delay in MA renewal)

• PRODUCT CHANGES: Change from MSC+ to MSHO or vice versa. **Requires transitional HRA

• TRANSFER: Existing BP enrollee transferred to you. Official notification via form 6.08 Transfer in Care Coordination

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Enrollment Terminology

NEW enrollee: Newly enrolled to Blue Plus. They may have previously been on FFS or another Health Plan. Includes switching products within Blue Plus (MSC+ to MSHO, they are considered a new enrollee)

Transfer: Actively enrolled Blue Plus member transferring from one BP Delegate to another. These are not considered new enrollees even though they may be new to the receiving Delegate.

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Reporting Discrepancies

• Email notification(s) sent when report(s) are ready for review

• Delegate reviews report(s) to identify discrepancies (i.e. mis-assigned members, a members name disappears)

• Report discrepancies to: [email protected] no later than the 15th of the month

• If the discrepancy for NEW enrollees is not reported by the 15th of the enrollment month, assigned Delegate is responsible for care coordination activities until the case is transferred the 1st of the following month

*Daily Add - discrepancies should be reported by the 15th day from the notification date*

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MEMBER CONTACT

REQUIREMNETS


Contact Requirements

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*Reminder: All members must be notified of their Care Coordinator’s info within 10 calendar days of enrollment notification*

Contact/year MSHO CW MSHO EW MSC+ CW MSC+ EW

Initial Face to Face 30 days

Face to Face 30 days



Annual Face to Face every 365 days

Face to Face every 365 days



Semi-annual(6 mos contact)

Minimum-phone contact

Face to Face (MSHO EW require 2 face to face visits/year)



TOCs ✓ required ✓ required ✓ required ✓ required

PCP Within 90 days, annually, COC, TOCs

Within 90 days, annually, COC, TOCs



**Enter all assessments into Bridgeview by 10th of the following month**


Blue Plus Health Risk Assessment Options

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Transitional HRA LTCC DHS 3428

ICF/DD Form Telephonic HRA

HRA Options


Using the Correct HRA

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• Newly enrolled member who had previous LTCC/MnCHOICES

• Must review and attach assessment and care plan to use Transitional HRA

• Reassessment is due 365 days from previous LTCC/MnCHOICES

• Change in product

• In person or telephonic

6.28 Transitional HRA

• Complete if no assessment and care plan received

• Update if previous assessment was incomplete

• Change in condition

• Requests new services (i.e. EW, PCA)

• Reassessment is due within 365 days of previous LTCC/MnCHOICES assessment

• Change in product (if no assessment within 365 days to review and attach to Trans HRA)

LTCC DHS 3248(HRA= LTCC)


Using the Correct HRA

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• Member who:

• Resides in ICF

• Assigned a DD Case Manager

• On disability waiver

• Copy of case mangers assessment and care plan must be reviewed and attached to 6.17

• Reassessment is due within 365 days of previous 6.17 ICF/DD assessment

6.17 ICF/DD

• Only for community well, non EW members refusing HRA

• Must offer a face-to-face HRA

• Must obtain consent for telephonic HRA

• Send copy to member/legal rep

6.40 Telephonic

HRA


Screening Document

The CC is responsible for entering LTC Screening Documents into MMIS for EW and CW when the member:

• Moves from FFS to Blue Plus

• Moves from another health plan to Blue Plus

• Change in Care Coordinator

• Switches products within Blue Plus (i.e., MSC+ to SecureBlue/MSHO or vice versa)

• An assessment is completed

• EW exit

EW reassessments must be entered into MMIS by the monthly capitation dates listed in the guidelines.

**Refer to DHS-4669 for Completing and Entering LTC screening into MMIS for MSHO and MSC+ Programs

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COLLABORATIVE CARE PLAN


Care Plan Elements

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Member

Medical

Contract Obligations

Social/Family

Personal Preference

Service Needs

Risk and Safety Needs


Comprehensive Care Plan

• 6.02.01 Collaborative Care Plan

• Contractual obligation

• Living document

• Must use Person-Centered Planning and language

• Must be completed and mailed within 30 days of the assessment

• CCP or summary must be sent to PCP

• Must be signed by CC

• Must obtain member/legal rep signature OR

• Document attempt to obtain member/legal rep signature

*Review guidelines for complete list of requirements39


Comprehensive Care Plan

SMART Goals: Specific, Measurable, Attainable, Relevant, and Time-bound

Prioritize Goals• Must contain at least one high priority goal

• Consider member’s specific situation, needs and preferences

• Prioritizing goals is a member-centered activity

Monitoring Progress/Goal Revision• Document progress at 6 month contact and/or as needed throughout the year

• Discuss each goal with the member including progress towards meeting the goal and documentation of whether the goal will be discontinued, modified, or carried forward to the new CCP

• Document the date (month/year) of the review and the outcome at re-assessment

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Goal Monitoring and Progress

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HOME CARE AUTHORIZATIONS


Home Care Services

Medical Assistance (MA) state plan home care services include:

• Skilled nurse visits (SNV)

• Home health aide visits (HHA)

• Private duty nursing (PDN)

• Personal Care Attendant Services (PCA)

• Physical, Occupational, Respiratory, and Speech Therapy (PT, OT, RT, ST)

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Home Care Authorization ProcessThe Care Coordinator must notify or request prior authorization from Utilization Management using one or both of the following Blue Plus forms:

6.04.03 MA Home Care Services Notification – Prior Authorization Request

6.05.05 PCA Authorization Request

Care Coordinators can authorize up to:

Up to 52 SNV per year (not to exceed 2 visits per week)

Up to 156 HHA visits per year (not to exceed 3 visits per week)

Up to 20 visits of MA non-maintenance PT, OT, ST

** Services beyond the limits above will need to be reviewed and authorized by Blue Plus Utilization Management**

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Medicare Covered Homecare Authorizations There may be times when Medicare may be the primary payer source for skilled home care services.

Here is what you need to know:

❖ CC should not submit any notification or prior authorization to Blue Plus for Medicare covered services

❖ Home care provider is required to notify the CC to assure continuity of services

❖ Refer provider to Quick Point (QP32-14) Home Care Authorization Clarification for MSHO and MSC+ Subscribers (located on bluecrossmn.com/providers)

❖ Provider questions should be directed to Provider Services 651-662-5200

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Homecare Authorization Reminders• Contact Utilization Management for questions related to homecare

authorizations

• Refer to contact information section of guidelines or MSHO and MSC+ Resources for contact information

• Extended Home Care authorizations do not require authorizations to Blue Plus. Service agreements should be entered into Bridgeview and Providers should submit claims to Bridgeview.

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PCA Process

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• Complete Supplemental PCA assessment with LTCC

• Send to Blue Plus

• Must use in-network provider

Assessment

• Prior to services Blue Plus reviews for medical necessity

Review• Decision is made within 10

business days

• CC is notified via secure email

• Letter is mailed to member

Determination


New Enrollees with Out of Network ProviderMembers with existing services:

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• Is current agency in network?

• If not, call member services for list of providers

Assess

• Use appropriate form

• Fax copy of previous authorization

Determine • May have authorization for up to 120 days

• Assist member to select in network provider

• Upon selection, complete appropriate form with new agency info

Assist


PCA Authorizations

• Submit form 6.04.05 PCA authorization request

• Attach completed DHS 3428D Supplemental PCA assessment

• For existing members must submit PA prior to start of services

• Member’s previously assessed with MnCHOICES; send in the MnCHOICESsummary report along with 6.04.05

• New enrollees with existing PCA services; submit form 6.04.05 within 30 days of enrollment

• If member open to EW, State Plan PCA must fit within Case Mix budget

**Blue Plus will provide coverage determination and authorization notification for PCA services to the Care Coordinator via secure

email

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Temp and Extended PCA ServicesTemp PCA

• Submit form 6.04.05 PCA authorization request• No face to face needed for temporary start

Example: If a member has a change in condition where immediate services are needed.

Extended PCA hours: • Must exhaust State Plan PCA services first• Must have an assessed and unmet need • CC may authorize under EW• EW service

• Must fit within EW case mix cap• Service agreements are entered into Bridgeview

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ELDERLY WAIVER


Elderly Waiver (EW)

When authorizing an EW service, CC must be compliant with all EW program rules, follow appropriate bulletins and directions using the following tools:

• MHCP Manual• CBSM• T2029 Supplies and Equipment Guide• Blue Plus Care Coordinator Guidelines• Bridgeview Care Coordination Delegate User Guide• Partner Relations Consultant

**These can be found on the resources page of this power point.

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Bridgeview EW Service AgreementsBridgeview Company is used to enter all EW service agreements and assessments for Blue Plus.

Care Coordinators are responsible to:• Be knowledgeable of the Bridgeview Care Coordinator Delegate User Guide

• Answer inquires from EW providers and Bridgeview Reps related to SA entries

• Update service agreements as needed

Separate Bridgeview training will be provided.

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Specialized supplies and equipment (SSE) T2029T2029 - Generic HCPCS code used for billing specialized medical equipment to EW. When using T2029, must include a service description.

• T2029 Guide (available on Bridgeview)- Blue Plus resource for determining appropriate payer. EW is the payer of last resort.

• Complete 6.06 Elderly Waiver Prior Authorization Request Specialized Supplies and Equipment for:

1. SSE item over $500

2. Item listed as "NO" under EW on the T2029 Guide

3. Chair portion of a lift chair is over $800

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DENIAL, TERMINATION, REDUCTION


Denial, Termination, Reduction (DTR)

Blue Plus reviews notifications of Denial, Termination, and Reduction of Services or eligibility for State Plan and Elderly Waiver Programs.

• Form 6.05 Notification of Potential Denial, Termination, or Reduction of Services must be faxed to Blue Plus within 24 hours of determination

• Multiple scenarios for when a DTR needs to be completed. See Guidelines for a list.

• DTR can be for both MA and EW services

• After Blue Plus reviews the request and if a DTR is needed, a copy of the DTR is sent via secure email to the CC and a copy with appeal rights is mailed to the provider and member

• State statute requires a minimum of 30 days advance notice for termination of services

• When in doubt, call Utilization Management

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DTR Scenarios

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Situation Action Needed DTR Requirement

Member goes into a hospital for

acute care (less than 30

consecutive days).

Close the line items in Bridgeview back to the admission

date

Not required.

Member goes into hospital for

more than 30 consecutive days.

Close the line items and service agreement in Bridgeview

back to the hospital admission date. Close the waiver as of

the hospital admission date.

Fax DTR on day 31 or within 24

hours of the determination that the

hospital stay will exceed 30

consecutive days.

Member goes into a nursing facility

(from community or short-term

hospital stay) for acute care/rehab

(less than 30 consecutive days).

Close the line items in Bridgeview Not required.

Member goes into a nursing facility

(from community or short-term

hospital stay) for more than 30

consecutive days.

Close the line items and service agreement in Bridgeview.

Close the waiver as of the NF admission date.

Fax DTR on day 31 or within 24

hours of the determination that the

NF stay will exceed 30 consecutive

days.


DTR Process –EW Closure

• Send in the DTR within 24 hours of determination that the member does not meet requirements to continue on the EW program

• Notify the financial worker via DHS 5181

• Communicate with member or responsible party regarding receiving appeal rights

• If closure is due to hospitalization 30 consecutive days or more, close line items in Bridgeview back to the hospital admission date

• If NF stay is longer than 30 consecutive days, close waiver span back to NF admission date

If you are unsure of the effective date, contact UM directly.

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DTR Exceptions

Notification of Potential DTR is not needed when:✓Member loses MA eligibility

✓Member moves out of the Blue Plus service area

✓Member changes to another health plan

✓Member dies

✓Services are “temporarily on hold” for less than 30 days and the same services will resume

✓Community well member who is determined eligible for EW but is not requesting any EW services

✓Change in service provider

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TRANSFERS


Transfers in Care CoordinationFollow this process when a member is transferring from a Blue Plus to Blue Plus delegate

• Initiating Delegate notify Blue Plus via form 6.08 Transfers in Care Coordination Delegation

• Upon receipt, Blue Plus will send form 6.08 to initiating and receiving Delegate for official notification

• The official transfer of care coordination assignment is the 1st of the month following the notification date on the form

• Form 6.08 will not be processed if any field is left blank

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Transfer Resources

Unsure of who to transfer to?• 9.07 Care Coordination Delegate Listing and

Contact Table

• Contact IHM Intake at 651-662-5540

• Consult with your Partner Relations Consultant

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Initiating Delegate Tasks• Share directly with new delegate:

• Assessment(s),

• CCP,

• Signed signature pages,

• RS tool,

• State plan home care authorizations

• If open to EW, keep active service agreements open in Bridgeview.

• Confirm PCC and address with member. Update in Bridgeview, if applicable. Update financial worker with changes to member address.

• See the guidelines for a complete list of tasks 63


Receiving Delegate Tasks

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Assign CC and enter in Bridgeview by the 10th of the month

Notify member of the assigned CC within 10 calendar days

Confirm PCC

Notify Physician

Notify FW of change

Enter SD into MMIS of CC change

Confirm HRA date

If no assessment or care plan received, complete new LTCC and CCP

Review guidelines for a complete list of tasks


Moving Out of Blue Plus Service Area • Check Blue Plus service area

✓Blue Plus MSHO and MSC+ is not offered in every county

✓Review 9.01 Blue Plus Service Area map or DHS 5825 and 4840

• Discuss implications of moving outside Blue Plus service area with member in advance, if possible

• Share with new health plan/county all applicable documents

• Waiver span remains open in MMIS

• Keep EW SA’s in Bridgeview open until member terms from Blue Plus

• Continue to Care Coordination until member terms with Blue Plus

• Connect member to Senior Linkage Line to select new HP

• Communicate to FW

✓Address change

✓EW eligibility65


TRANSITIONS OF CARE


Transitions of Care (TOC)

The Care Coordinator is key to supporting the member’s needs across the continuum of care. The goal is to reduce incidents related to fragmented or unsafe care and reduce readmissions for the same condition, planned or unplanned:

• Delegate will receive notification from Blue Plus when Blue Plus receives notification from the hospital/facility

• Use 6.22.01 Transition Log Instructions as a resource (available on CC Portal)

• Document transition activities on 6.22 Transition of Care Log (date each field)

• Unrelated transitions should be started on a new transition of care log

• All TOC activities must be completed within 1 business day of notification

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Transitions of Care (TOC)

If CC learns of transition 15 days or more after the member returned to their usual care setting, no log is required. CC should reach out to member or responsible party to discuss:

• Transition process,

• Changes to the member’s health status,

• Plan of care, and

• Document information in case notes

**It is best practice to follow up with the member or responsible party to assess if other services are needed, use your discretion depending on when you learn of the transition.**

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RESOURCES


Resources

Utilization Management/Intake: • 1-800-711-9868 or 651-662-5540 • Prior authorizations • DTRs• Notifications to CCs• Identify care coordinator for transfers

Clinical Guides: • 1-866-518-8447 • [email protected]• Pre-Admission Screening• Member-specific issues and questions• Out of state hospital coordination

Delta Dental Coordinator Line • 1-866-303-8138 or 651-994-5198• For CC use only to assist members with dental needs

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Resources

Disease Management:• Telephonic case management program for chronic conditions

• 6.09 Health Management Referral form

Behavioral Health Clinical Guides: • 1-866-489-6947 (select option 1)

• Mental Health and Substance Abuse consultation

• Crisis assessment and intervention

• Referrals

• Case Management

Member Services: • 651-662-6013 (MSHO)

• 651-662-5545 (MSC+)

• Assistance finding a provider

• Benefits question

• Interpreter services

• Questions/appeals/grievances 71


Resources

Bridgeview:

https://www.bluecrossmn.com/healthy/public/bridgeview/home/

Blue Plus CC Web Portal:

https://www.bluecrossmn.com/carecoordination

BlueRide Portal:


Enrollment Questions/Discrepancies:

[email protected]

Partner Relations Team:

[email protected]

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https://www.bluecrossmn.com/healthy/public/bridgeview/home/

https://www.bluecrossmn.com/carecoordination





Resources

• MHCP Manual

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_000094

• Bridgeview Links and Resources:

https://www.bluecrossmn.com/healthy/public/bridgeview/home/ewpd-old/!ut/p/z1/04_Sj9CPykssy0xPLMnMz0vMAfIjo8ziTQw9PA08_Q28DUyCnQwcA0NNHL3DLA3NDE31wwkpiAJKG-AAjgZA_VGElBTkRhikOyoqAgDgFAkf/dz/d5/L2dJQSEvUUt3QS80TmxFL1o2XzQxSEkwSU8wS09USzIwQVE5QzlKUkVBSVA2/

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http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_000094

https://www.bluecrossmn.com/healthy/public/bridgeview/home/ewpd-old/!ut/p/z1/04_Sj9CPykssy0xPLMnMz0vMAfIjo8ziTQw9PA08_Q28DUyCnQwcA0NNHL3DLA3NDE31wwkpiAJKG-AAjgZA_VGElBTkRhikOyoqAgDgFAkf/dz/d5/L2dJQSEvUUt3QS80TmxFL1o2XzQxSEkwSU8wS09USzIwQVE5QzlKUkVBSVA2/


Common MMIS Documents

• DHS 4669, Instructions for completing and entering the LTCC Screening Document into MMIS for MSHO and MSC+ Programs

• DHS 3428 MN Long-Term Care Consultation Services Assessment Form

• DHS 3428A MN Long-Term Care Consultation Assessment form: SW Section

• DHS 3428B AC,BI, CADI, EW Case Mix Classification Worksheet

• DHS 3428D Supplemental Waiver PCA Assessment & Service Plan

• DHS 3427 LTC Screening Document

• DHS 3427T LTC Screening Document- Telephone Screening

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QUESTIONS?