LTC CMR Basics
If the member knows their medications and is comfortable continuing the call, this is what the associate should do.
What is complete the CMR as normal with the member?
Before giving LTC staff the member’s DOB, the associate must first verify these two things.
What are the facility name/address and the staff member’s first name/title?
This is the CMR fax number LTC facilities can use to send a medication list.
What is 855-537-3348?
A faxed or emailed LTC medication list must be dated within this many days for the initial full prep.
What is 3 days?
If the member resides in an LTC facility, this question on the MTM CMR Assessment must be answered YES.
What is the LTC question?
If the member says the LTC manages and administers their medications, the associate should ask for this information.
What is the name of the LTC facility?
After reaching clinical staff, the associate asks whether the member is cognitively impaired in these three areas.
What are thinking, memory, or judgment?
This is the email address LTC facilities can use to send the medication list.
What is CMRMedicareCPCC@
carelon.com?
If the medication list is outside the 3-day window, the associate should contact the LTC and request this.
What is an updated medication list?
When the CMR is completed with clinical staff, the clinical staff should be documented this way on the MTM CMR Assessment.
What is Caregiver, not Provider?
Before disclosing the name of the LTC facility during a member call, this must be completed.
What is HIPAA verification?
If LTC staff are unsure whether the member is cognitively impaired, associates may ask for this screening score.
What is the BIMS score?
The fax should be marked “ATTN” with these two items.
What are the associate’s name and CMR Team?
A fully prepped LTC CMR medication list remains valid for this many days.
What is 30 days?
When a CMR is completed with LTC staff, the management reason is closed this way.
What is Addressed with Member/Provider?
When a member asks, “What is a comprehensive medication review?” the QRG gives this simpler description.
What is a medication list review?
According to the QRG, this BIMS score range may support cognitive impairment.
What is 0–7?
If LTC staff push back because they are busy, one option is to ask them to fax the medication list and do this afterward.
What is call back after reviewing the list?
If the pharmacist completes the CMR more than 3 days after fax receipt but within 30 days of full prep, the pharmacist must do this first.
What is call the LTC and confirm whether there have been any medication changes?
If LTC staff agree to fax or email the medication list but the CMR is not yet completed, the CMR management reason is closed this way.
What is LTC CMR, with the case closed as Completed?
After confirming the member wants the LTC contacted, the facility phone number should be made this in HIP.
What is the primary phone number, with Consent and Other selected for Phone Type?
When a member or representative prefers that the CMR be completed with nursing/clinical staff, that staff member should be added in HIP using this process.
What is the Informal Representative process?
Whenever LTC staff push back, the QRG says associates should always offer to do this.
What is fax an official letter explaining CPCC services?
The maximum Busy/Research prep time allowed without manager pre-approval is this long.
What is 30 minutes?
If no medication list has been received after this many days, the POC emails the associate and an optional second outreach may occur.
What is 7 days?