AUTHORIZED REPRESENTATIVES MISSOURI HOSPITAL ASSOCIATION Missouri Family Support Division

AUTHORIZED REPRESENTATIVES

MISSOURI HOSPITAL ASSOCIATION

Missouri Family Support Division

Welcome!

Presenting from Missouri FSD:

Julie Gibson, Designated Principal Assistant Glenda Deason, Manager, MHABD Medical

Review Team Processing Center, Springfield, MO Linda Simmoneau, Program Development

Specialist, Medical Review Team

FSD Modernization and Reorganization

Upgrading to new/modern technology – MEDES – replacing existing legacy system (FAMIS) Web-based, automated system Stronger case management tools Cheaper to operate and maintain

Phase I -- MEDES – MAGI Medicaid (January, 2015)

Phase II will focus on Non-MAGI Medicaid (elderly, disabled) – (2016)

FSD Reorganization

Key Elements of FSD Reorganization: Centralizing application processing/

specialized customer services Creating Customer Resource Centers

throughout the state Employing call center technology and

processes Converting paper case files to electronic

format

WHAT CHANGES WILL YOU SEE?

How does this impact Authorized

Representatives?

MHABD MRT Specialization “MRT Central”

MRT Central will enable faster and more efficient processing and will provide a centralized point of contact for Authorized Representatives

Consolidates processing of MHABD MRT to one primary location – Greene County, Springfield, MO

Eligibility staff and Medical Review Team work hand in hand to expedite processing of MHABD MRT applications from start to finish

MRT Central staff become a “specialized team” in processing MHABD MRT applications

Partnership with Authorized Representatives

MRT Central values the important partnership with ARs and is committed to providing excellent customer service

STL AR is transitioning operations to MRT Central – all information sent to the STL AR Group will be forwarded to MRT Central via e-mail

Please begin using this new email address that has been established solely for applications from hospitals and facilities: 

FSD.HospitalApplications@dss.mo.gov

MAKE SURE THAT THE APPLICATION AND OTHER

REQUIRED FORMS ARE COMPLETED THOROUGHLY 

How can Authorized Representatives help expedite processes?

MHABD Forms

IM-1MA Application for Benefits  IM6-AR – Appointment of Authorized

Representative MO-650-2616 – Authorization for Disclosure

of Consumer Medical/Health InformationIM-61B – Disability QuestionnaireIM-61C Work History in the past 10 years  IM-61D Hospitals, Medical Facilities and

Physicians seen within the Past Year

MHABD Verification Forms

IM-9 Insurance and Prepaid Burial Verification Request

IM-12 Employment Information Verification Request  

IM-7 Financial Information Verification Request

IM-1MA Application for Benefits

Tips for Completing the IM-1MA Application

If applicant is homeless – be sure and note this on the application and include a mailing address – which can be the hospital/authorized representative’s mailing address 

Ensure that the type of application is marked, i.e. disabled, over 65, blind/visually impaired.  If client is wishing to pursue Gateway to Better Health, please write that in

If married and living together, both spouses must be listed on the application

All types of income, earned or unearned, should be listed on the application

IM-1MA (Cont’d)

Make sure all resources are indicated on the application

Ensure that the application is signed and datedPlease make sure we receive the completed application

as soon as possible, especially if it is late in the month For example, if the client fills out the application and it is dated for March 30, but we don’t receive it until April 1, then April will be the month of application

If the client does not have unpaid medical bills prior to the month of application, it may not be necessary for you to go through the need of obtaining information for the months prior (see next slide)

Prior Quarter Coverage

Indicate on the application whether or not prior quarter coverage is needed. 

MOHealthNet may cover outstanding medical costs incurred by the applicant (or spouse) in the 3 months prior to the month application is received

All types of income, earned or unearned, should be listed on the application, including prior quarter

Make sure all resources are indicated on the application, including any owned in the prior quarter

Options for Authorized Representatives

Consider the level of involvement you want/need to have on behalf of a client

FSD allows for several options that will enable a provider to assist the client:

1) Become a legal Authorized Representative by completing IM-6-AR

2) Client can give FSD permission to discuss his/her specific case with you (without making you

an official AR) by notating on the MO-650-2616 (HIPAA form) 3) Client can give FSD the same permissions as # 2 by completing the newly created IM-6-NF

IM6-AR Appointment of Authorized Representative

 IM6-AR – Appointment of Authorized Representative

As an Authorized Representative, you become FSD’s primary contact for the client: Represent the client in Hearings Receive all correspondence on behalf of client Access to client case information Speak to FSD on behalf of the client

In completing the IM-6-AR: Ensure that this form is completed in its entirety  Must be signed by the Authorized Rep, or it cannot be

accepted Make sure that the form is legible Please print your name behind your signature

MO-650-2616 – Authorization for Disclosure of Consumer Medical/Health Information

MO-650-2616 – Authorization for Disclosure of Consumer Medical/Health Information

This is often the most confusing form for the client to complete

Please have the client sign this form in black ink.  MRT Processing must have signatures that are visible

in order to obtain the appropriate medical records needed /schedule necessary evaluations

Ensure that both signature lines are signed on the back of the form

Make sure that the individual has NOT signed the revocation area

IM-6-NF AUTHORIZATION FOR RELEASE OF MEDICAL/HEALTH INORMATION TO THE NURSING FACILITY

IM-6-NF AUTHORIZATION FOR RELEASE OF MEDICAL/HEALTH INORMATION TO THE NURSING FACILITY

A user-friendly form that gives FSD permission to discuss a person's case with the provider 

Alternative to the IM-6-ARDoes not make the provider the Authorized

Representative

IMPORTANT TO ENSURE THAT THEY ARE COMPLETED AND

SUBMITTED

Other MRT Forms

IM-61B – Disability Questionnaire

IM-61B – Disability Questionnaire

This form is the voice of the individual when MRT is making a determination. 

Must be completed thoroughly MRT Processing must know ALL medical

conditions of the individual  This form also helps to determine if any other

evaluations need to be scheduled for the client

IM-61C Work History in the past 10 years

IM-61C Work History in the past 10 years

FSD must obtain employment information for the past 10 years

The individual must make every attempt to provide accurate and complete information

IM-61D Hospitals, Medical Facilities and Physicians seen within the Past Year

IM-61D Hospitals, Medical Facilities and Physicians seen within the Past Year

Provide information for all medical services the individual has received in the most current year

FSD will not be requesting records older than one year

The dates of service are critical to obtaining the relevant medical records – be sure to include them

IM-9 Insurance and Prepaid Burial Letter

IM-9 Insurance and Prepaid Burial Letter

This form is required if the individual has any life insurance or burial policies, and must be completed and signed by the client 

The name of the company is requiredThe company address is requested, if

available

IM-12 Employment Information Request

IM-12 Employment Information Request

This form can be supplied if paystubs are unobtainable by the individual 

Ensure that the form is signed Ensure that the employer name and address

is provided:   It is very important that we know the location of

the employer where the client works/worked, especially since many are franchised or have multiple locations

IM-7 Financial Information Request

IM-7 Financial Information Request

This form is completed by a bank/financial institution, and is necessary if the client does not have access to, or does not provide their financial institution/bank account verification

If the individual has access to their information, please have them attempt to obtain the information themselves, as some banks charge a fee for filling out the IM-7

MHABD Authorized Representative Case Status Report

Starting April 1, 2015: AR will receive “Vendor” Case Status Report Semi-Monthly

Two “Vendor” Case Status Reports E-mailed to AROn 1st each month status for prior month

from 16th to last dayOn 16th each month status for current

month 1st to 15th

 Will develop a customized report for ARs in the near future

MHABD AR Case Status Report (Cont’d)

Current “Vendor” Case Status Report contains the following fields:

Participant Name (AR) Case Number (for AR zeroes) Application Date Referral Received Date Application Status

Pending Approved Not Eligible

Effective Date of Status

Vendor Case Status Report

Final Notes

FSD.HOSPITALAPPLICATIONS@DSS.MO.GOV

This email address is monitored 100% of every business day

MRT Central will follow-up on any pending AR applications

If you do have an urgent matter, you may call Glenda Deason at 417-895-6062

Also, check out our updated website at dss.mo.gov/fsd/