PCS Assessment
This assessment is conducted once a new request for PCS is accepted
What is an Initial Assessment
The beneficiary is not available for assessment within 30 days of due date this will occur
What is a technical denial with appeal rights
An appeal can be filed when one of these four things have occured
What is services:
Denied
Suspended
Reduced
Terminated
All PCS providers are required to use this system to manage active PCS beneficiaries
What is QiReport system
A Transition Coordinator completed this with a nurse on the phone
What is a mini-assessment
Before scheduling assessments the request(s) are approve by
What is a Request Processor
An appeal submitted between days 11-30 is approved for MOS when
What is the date OAH receives the appeal request
This hyperlink is used to switch the NPI for the beneficiary
What is the Provider Number Change
The standard PCS assessment is completed in how many days
What is 14 business days
Any appointment that is not cancelled or rescheduled prior to scheduled appointment date or time
What is a no-show
This person presides over the OAH hearing
What is the administrative law judge
This has to be completed for the PA to generate
Daily Double
This assessment includes the home environment to identify any health or safety risk to the beneficiary or PCS aides who will provider services
What is a In-home assessment
Rescheduling of assessment may be given at
What is up to three times
A beneficiary who files a timely appeal may continue to receive the same level of service is called
What is maintenance of service
Referrals in need of attention are located here
What is Referral/Notifications for Review
This assessment is scheduled before the end date of the current authorization
What is an Annual Assessment
If unsuccessful with beneficiary contact attempts will be made three times within
What is 10 business days
Daily Double
These people are included in the mediation:
What is
The Mediator
A NC Medicaid Representative
The Beneficiary Representative
This can cause a PA to be deleted/end
What is a Discharge