LTSS
These are required to be performed yearly or when their is a change in a members condition.
What is an InterRai
This information should be in the alert box for members.
Diagnosis not listed under ICM conditions of interest, deceased and DOD, New phone #'s addresses, alternate contacts, safety information or other pertinent information that may be needed.
This is not required to be documented/charted for ID/DD members.
97 A/B, CES tool, CES Event
The members personal Long term goal should be written in this type of format.
What is an "I" statement.
Invitations are sent to the member, PCP, caregivers or specialist to attend this meeting within 30 days after every HRA or change in condition assessment.
What is an ICT
You will automatically fail a chart audit without this documented.
What is the NCQA note
Under ICM special interest sub groups when would Mandatory High be checked.
PDN/Vent members and member who have discharged from a NF LTC stay within the last 6 months.
The flu event is required during these months
September thru March
Where do you document in the CP the members cultural and language preference.
In the CP member contact preference event.
Members are changed to this stratification level for 6 months after being discharged from a NF level 1 stay.
what is intensive
What are the different requirements between Intensive and supportive member interval assessments?
What is Interval assessment every 30 days for Intensive, 90 days for supportive and quarterly F2F visits for both.
What should be checked under the ICM special interest subgroups.
Everything that applies to that member based on their population type.
These must be documented for each condition/diagnosis in the NCQA note.
What is the status of the diagnosis, how is it being treated and what if any doctors are following.
This must be reviewed/revised for any changes during interval assessments, change in condition assessments or InterRai assessments.
What is the Care Plan?
These can no longer be used when documenting in a note or in the medication form
What are abbreviations
This is must be completed when talking to someone other than the member if there is no POA or ROI in the chart.
Hippa Event
When would a member episode need to be closed and reopened?
What is: When a member changes level of care , change from M&C to supportive or left Aetna for 30 days or more and came back to Aetna.
This should be added to the text box for each item in the NCQA assessment progress note.
What is CM concludes ____________as evidenced by CM member assessment, member conversation and/or caregiver conversation
If the member’s signature is not obtained at the first attempt, CM staff should do this.
Make at least two subsequent attempts to obtain the member’s signature and document attempts in CM Activity Tracker.
These must be charted within 24 hours of a yearly, or change in condition assessment visit.
What is the InterRai and NCQA note.
What is the extra form that is required for members with a TA waiver when entering their LOCERI.
What is 108 for adults and 109 for children?
This should be done if a newly assigned members number is missing from or incorrect on the episode page?
Check authorization requests for SF or agency information and to find information for backup caregivers and formal supports, CMAT notes, CEC snapshot, PCP, QNXT claims and collective medical at a minimum. Other ways: HCD portal, obituaries (google), google search.
This form is required yearly with the LOCERI for members using ADHC services.
What is the IES form
These two types of supports must be included on the CP and NCQA note for every member.
What are formal and informal supports
What do you look for in QNXT for ALL members newly assigned to your caseload.
What is: Was there a previous rate code under eligibility? When did rate code/lob change to LTSS?