Case Transition Process
Date of the most recent Case Transition Process update.
What is 10/18/21?
Completed when depression score is >3 on HRA.
What is the PHQ9?
Bimonthly outreaches are ___ attempts?
What is 2 attempts?
Reportable Critical Incidents
Abuse, Neglect, Exploitation, Misappropriation (>$500 value), Unnatural or Accidental Death.
The date OhioRISE started.
What is July 1, 2022
Template used to change members risk level.
What is the ICCA template?
3 days
What is the TOC outreach timeline?
Outreach attempts schedule
What is 1 rounds of 3 calls and unable to reach letter and 1 round of 2 calls and unable to reach letter?
Additional Reportable Critical Incident for OhioRISE members only.
What is Natural Deaths?
Who covers members' medical needs?
What is UHC.
The queue that CSP members are transitioned to for the remainder of their Lock In status.
What is the Oh Level 1 Queue?
Length of CSP Lock in program.
What is 2 years?
*Can be extended with review.
Yearly scripts
What is a Peds/Adult Core and Ped/Adult HRA?
We have _____ hours from discovery of incident to report to Incident Team (greferralsoh@uhc.com)
What is 3 hours?
Eligibility for OhioRISE
What is eligible for Oh Medicaid, age 0-20, not enrolled in My Care Oh plan, require sign. BH needs
Members that get transitioned to OH HFS Monitor Queue.
What is HFS member in a hot-spot zip code area?
***If NOT in hot-spot zip code, get transitioned to Workgroup: OH Inactive
New SDOH resource website.
What is Wellsky?
CM uses this for level 3 Pediatric and NICU members while the CHW uses this for all members.
What is the Focus Note.
Incident team has ______ calendar days from date of discovery of incident to complete investigation.
*unless extension approved by ODM
What is 45 days?
CANS stands for this.
What is Child Adolescent Needs and Strengths Assessment.
Populations that always require care coordination from field CM staff regardless of agreeing to Case Management.
What is AEW (Adult Extension Waiver), PDN, and members utilizing metabolic formula
NW Team
What is the BEST staff/team anyone could ask for!!!
CM uses this for Level 4 Pediatric and NICU member ftf visit when Pediatric Core not needed.
What is SOAP note?
CM has ____ days to notify member of investigation outcome.
What is 7 days.
* unless jeopardize health/welfare of member-then must notify incident team to document in IMS.
Agency that approves disenrollment.
What is ODM?
*Member/Family needs to request A Just Cause request by contacting Medicaid Consumer Hotline at 800-324-8680. M-F 7a-8p and Saturday 8-5p.