€¦ · Web viewbutton—you would do this if a provider contacted you by phone, for example, and you wanted to enter the request for them. If you’re still in the process of creating

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AlphaMCS Portal-Discharge Requests

This document encompasses the discharge process to submit to CDW. When a client is discharged from a provider, this can be tracked in the Discharge module. This module will also track if someone has gone 60 days without services (SA) and MCO staff need to discharge them from state insurance.

Discharge ProcessWhen a provider or MCO staff discharges a patient, they will submit a discharge request that the MCO staff can review and acknowledge or send back. To view discharge requests, go to Menu > Discharge. By default the list will populate with all discharge requests currently assigned to the user logged in.

The Full Discharge checkbox is used by MCO staff to approve a request. This box is only active when the system generates the discharge for SA consumers after not receiving services for over 60 days.

The SA Move checkbox is used if an SA client has been identified as having no billable service in 60 days, but the MCO has determined that the client should not be discharged. Submission of a Substance Abuse Treatment (Movement) Details record (type 18) will identify that the client is still actively receiving services. Note: In addition to the Substance Abuse Treatment (Movement) Details record, a Diagnosis Details (13) and a Substance Abuse (Drug of Choice) Details Record (17) must be sent.

For the system to identify SA patients, the latest claims and the procedure code are used to get the diagnosis group description. If the description is SA, and that patient has not had claims in 60 days, the request is auto created.

When a provider or MCO staff member determines that a patient should be discharged, they will submit a discharge request for UM staff to review. The reviewer will then either complete the discharge or send back to the provider.

The My Discharges button will show the discharge requests that are assigned to you for acknowledgement with the status ‘Submitted’. You can also create your own request by clicking the Create button—you would do this if a provider contacted you by phone, for example, and you wanted to enter the request for them. If you’re still in the process of creating the request and have saved it, then those will also show on your queue as ‘Saved.’

The All Discharges view allows you to see all discharge requests that are currently waiting for submission.



The discharge Status can vary depending on the state of the discharge request.

Status: chosen accordingly to identify the current state of the processo Saved: the initial status before any action is takeno Submitted: discharge requests that are assigned to you for acknowledgemento Sent back to Provider: a provider submitted request that was sent back for discrepancieso Discharged: identifies that the consumer was discharged in CDWo SA Move: identifies that this type was submitted



To edit a saved discharge request, click on arrow to the left of discharge request, then Update.

On this screen, you can take an action as well as view specific information related to the discharge, including a final level of care, referral information, living arrangement and employment status among other relevant information.

To update a discharge request from saved to submitted status, select ‘Submit’ at the bottom right corner of screen.



To access discharge request details, from the expanded view, select Details. By selecting, View, a read only view of the discharge request will display.

When selecting Details, an additional four sections within the Discharge module will display providing more information on the patient and the discharge request. Theses sections include: Authorization, Claims, SA Move Details and Reviewer Comments.

Authorization will show you any authorizations that a consumer has for quick reference.

Claims allows you to view all claims related to that client. This can be useful when making a decision about a discharge request.

SA Move Details provides history and information about any completed SA Moves.

Reviewer Comments displays comments made by reviewers of the selected discharge.

When a full discharge is approved by the MCO staff, a discontinued date will be initiated and will be viewable on the Authorization in the Authorization module and patient auth record. State insurance policy will be end-dated with the discharge date.



Discharge Process Flow

Documents

€¦ · Web viewbutton—you would do this if a provider contacted you by phone, for example, and you wanted to enter the request for them. If you’re still in the process of creating