Note Types
What does the Care Shaping note type document?
Clinical consultation with provider
Which note type is used to document a member being confirmed for METS work?
Clinical Case Status - Confirm Note
What is the purpose of a METS Communication Note?
To record administrative provider outreach (i.e. Intro to METS, follow up on correspondence, scheduling)
Maximum of 7 days.
What should be included in every note?
CL credentials
What 3 things must be included in a Follow-Up note for UTR, LOE, or RTE reasons?
Provider Name, Provider TIN, Provider Zip Code
True or False: A member can be moved to Follow-Up status without being confirmed first.
False
What does the acronym “UTR” stand for in METS documentation?
Unable to Reach
This is the typical duration a member is followed by the METS program.
3-9 months
True or False: A CL should cancel the initial assessment call if clinical documentation is not received beforehand.
False
Which note types is used to document a member presented in TTR? (Both notes needed)
TTR Note and MD Escalation Note
What are 3 things a CL does during 2nd level triage for an Active member?
Enter a METS Alert in TC, Complete Clinical Case Status Note with CONFIRM, Add member to personal census
What must be included in a UM Consult note?
Authorization number and assessment info
The providers are reimbursed this amount for METS Consultations?
no reimbursement; 0 dollars. METS consultations are part of contractual requirements of participation in quality initiatives and programs with the HP.
This report is uploaded every Monday and includes all active members’ claims from the past 6 months.
The Ongoing Report
What note type is used when a CL reviews an authorization but does not consult with UM?
Findings Note
Which of the following is NOT a valid reason for Follow-Up status according to the follow up reason options? No claims activity in 90 days, Provider refused to engage, Successful titration of services, Member transitioned to LTSS
Member transitioned to LTSS
What must be included in a note if it is entered after the day the event occurred?
LATE ENTRY: and the actual date/time
This federal regulation allows providers to share PHI with METS without member consent.
HIPAA Privacy Rule (45 CFR 164.506)
This type of code is used to identify behavioral health services.
CPT Codes
Which note type is used to document preparation for a Treatment Team Review (TTR)?
Findings Note
True or False: Idle members are reassessed and may reappear on the MML.
True
Name 3 things that should be included in the Initial Findings narrative?
BH diagnosis, Member age, Services receiving, Provider Name, Service dates and history, HEDIS gaps
What are the 2 things you should attach to a provider intro email?
Provider FAQ and METS Provider Flyer
What are 3 frequent CPT codes used in your market?
Varies by Market. Confirm with People Leader