Medical Necessity Determination Process Assessments are reviewed by TMHP nurses within 3 business days of receipt. Assessments are reviewed by TMHP nurses within 3 business days of receipt. Assessments may remain in pending denial up to 21 calendar days. During this time additional pertinent medical information may be submitted for review. Assessments may remain in pending denial up to 21 calendar days. During this time additional pertinent medical information may be submitted for review. If an assessment is placed in a “denied” status, additional information must be received within 14 calendar days of the date of denial letter. If an assessment is placed in a “denied” status, additional information must be received within 14 calendar days of the date of denial letter. Replaces slide 38

Portal: FSI Replaces slide 63

Corrections If incorrect data on the MN and LOC Assessment is submitted or RUG of BC1 has been assigned, the provider can submit a correction. If incorrect data on the MN and LOC Assessment is submitted or RUG of BC1 has been assigned, the provider can submit a correction. –Examples of incorrect data are:  Individual listed as a male but is actually a female.  Individual’s diagnosis notes diabetes but the individual actually has hypoglycemia. Corrections are not allowed to all assessment fields (i.e., individual demographic information and assessment date). Corrections are not allowed to all assessment fields (i.e., individual demographic information and assessment date). Providers must access the assessment utilizing Form Status Inquiry (FSI) or Current Activity. Providers must access the assessment utilizing Form Status Inquiry (FSI) or Current Activity. Corrections must be completed on the LTC Portal within 14 days of original submission. Corrections must be completed on the LTC Portal within 14 days of original submission. TMHP will place the original assessment into a corrected status and give the new assessment a DLN creating a Parent/Child DLN relationship. TMHP will place the original assessment into a corrected status and give the new assessment a DLN creating a Parent/Child DLN relationship. Replaces slide 68

Inactivations MN and LOC Assessments can be inactivated from the system. MN and LOC Assessments can be inactivated from the system. –An example of an inactivation is when fields cannot be corrected. (i.e. Medicaid # and individual name) Inactivations must be performed through the LTC Online Portal by a search through FSI or Current Activity. Inactivations must be performed through the LTC Online Portal by a search through FSI or Current Activity. There are no time limitations to perform an inactivation. There are no time limitations to perform an inactivation. Assessment will be placed in a status of “Inactivated”. Assessment will be placed in a status of “Inactivated”. Once the assessment is inactivated it cannot be “reactivated,” and a new assessment must be submitted. Once the assessment is inactivated it cannot be “reactivated,” and a new assessment must be submitted. Replaces slide 71

Status and Messages Providers can retrieve the status of their MN and LOC Assessment by accessing FSI or Current Activity on the LTC Online Portal. Providers can retrieve the status of their MN and LOC Assessment by accessing FSI or Current Activity on the LTC Online Portal. –Medical Necessity (MN) Approved - Assessment has been reviewed and approved by TMHP. No further action by provider is required. –Pending Medicaid ID - The system is verifying the Medicaid ID. No further action by provider is required. Replaces slide 73

Status and Messages (cont.) –ID Confirmed- Individual’s Medicaid ID has been confirmed for the dates of service submitted. Provider must submit/update all required assessments and forms. Replaces slide 74