New Member
How will the new members be distributed to the Team PC's?
The change agents will distribute/assign new members to the Team PC's
Where would you find the members' diagnosis, and medications?
Members diagnosis and medication will be located on the H&P received from PCP
What document will you reference to locate member allergies and add into TruCare under allergies?
The PCSP is where you can locate members allergies
When should the PCSP (Person Centered Service Plan) get faxed to PCP?
The PCSP should be faxed to the PCP only during the Initial Assessment, if there was a change in condition (CIC), and during Annual Assessment
When is an escalation needed?
If the CM is notified of missing elements in their chart and corrections are not made.
What letter do we send to new members?
We send the welcome letter to new members
Where would you upload the fax confirmation for the PCP outreach?
Where would you enter the HCBS members location?
Members location would be entered in the members demographics
How would you know if the CMA was completed?
Using the assessment summary, the CMA will have a start date and completed date
How long should you wait to escalate an issue a chart?
The chart should be escalated in 3 business days if not resolved.
What tasks are built with the new member set-up?
The task that will be built are:
Initial Contact
Complete Assessment
Follow-up with Primary Care
LOC Redetermination
Where do you find the member’s location (address), personal and provider contacts to update in TruCare?
You can find members address, personal contacts and provider contacts on the Care Plan
What tool is used to generate the member’s next quarterly assessment visit and PCP follow-up?
The task calculator tool is used to add/update members next quarterly assessment visit and PCP follow-up
In the demographics section, what fields are you populating? Where are you pulling this information?
Members ethnicity, race, religion, primary language, problems with hearing are all the fields that will be populated.
This information is being pulled from the CMA
How will the CM be notified of an escalation?
The CM will be notified in two ways if an item has been escalated:
Via email through Microsoft List.
The corresponding task will be returned to the CM queue.
Where would you upload the checklist once your review is complete? If elements are identified for escalation, how do you address them?
The checklist will be uploaded with in the General note.
If elements are identified, an escalation log should be completed and sent to the CM
What assessment would we use to locate the BH score? If the score is 10+, what do you do?
The CMA is the assessment that would be used to locate the BH score.
If the score is 10+, check and see if there is a BH referral.
How would you distribute the member’s CP (Care Plan)?
Members Care Plan (CP) would be distributed using correspondence
Where do you find the information for educational material?
Information for educational material is located in Krames
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What happens when the escalation is addressed?
The task can be closed. No further action is needed
Where would you find the members PCP (Primary Care Physician)? What would be the next steps?
Members PCP can be located using Impact Pro.
The next steps: search PCP in the NPI registry, contact PCP using mock script, and fax the H&P fax request
Where do you build Care Plan for Care Gaps?
The Care Gap Care Plan is built within the Care Plan in TruCare.
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How would you add member’s location for Nursing facilities?
In TruCare navigate to the Members location and add a new location.
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What are you using DMAP (Delaware Medical Assistance) to check?
Using DMAP to check if member is eligible with DFH, their waiver type is correct, and if the LOC have an effective date.
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What happens if the escalation is not addressed timely?
CM will receive a second email notification within 3 business days to ensure awareness and prompt resolution.