Forms
Processes
External roles
MNLOC
General
100
Only the SPW services are checked off on this form.
What is H1700-1?
100
When the member has Medicare, Medicaid and SPW often the SC will need to determine this.
What is the primary payer?
100
This is who SC will refer member to if they need dental care.
What is Dentaquest?
100
This is the reason RN's are required to fill out the MNLOC.
What is nursing judgment / assessment skills?
100
When meals are delivered to the home it is called this.
What is HDM?
200
When there are variations in the time frames on the MNLOC it is called this.
What is/are look back times for MNLOC ?
200
This documentation/form should not be signed in the home on the day of the assessment and is mailed out for signature later.
What is the 1700-A1?
200
TMHP is the acronym for this external program.
What is Texas Medicaid Healthcare Partnership?
200
This is the date used for the 7 day look back?
What is the assessment date?
200
This is the member that loses all their Medicaid services with the MCO if they do not meet or lose their Medical necessity.
What is an MAO member?
300
This is the form that is sent by the PSU to identify MNLOC approval and includes the ISP dates.
What is 2065D?
300
This is the product (program) the member will convert to if they require PAS and ERS, meet MNLOC but do not need any waiver service
What is CFC?
300
The SC must have documentation from either a HH agency or the MD before checking this question on the MNLOC.
What is documentation that has to be verified before checking the question that the member has less than 6 months to live?
300
This is the number of days TMHP has to review the MNLOC to determine approval or denial.
What is 5 days?
300
The SC must do this to documentation if a service is not authorized.
What is the documentation that explains why a service was not authorized?
400
This is the form that lists the member's non waiver (third party) sevices.
What is 1700-B?
400
You will start the process for this/these services if needed while waiting for the MNLOC approval.
What is the time you will do an Auth template and request for Non waiver services.
400
The B section of this form, utilized for the Interest List member, may need the help from the SC to complete.
What is H3676?
400
When you have a BIMS score that does not match your observations this is where you will document this information.
What is the comment section?
400
If the member does not agree with a denial for MNLOC they can ask for this process.
What is Fair Hearing?
500
This member will have their PAS and ERS listed on the H1700-1.
What is MAO.
500
In this assessment process the MNLOC cannot be submitted to TMHP until the MD signature form has been received.
What is the initial, upgrade, MDCP, Interest list assessment.
500
This is the form for an Interest List member that is sent to SHP by PSU.
What is H3676?
500
This is the waiver service that will be ordered on th 1700-1 if the member is interested in getting a job.
What is Employment assistance.
500
DAHS, Acute care services, habilitation are this kind of services.
What is a non waiver service
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