PRIOR AUTHORIZATION
Member Eligibility and Service Verification.- The MassHealth Minimum Data Set Form (MDS).
- Primary Care Physician (PCP) Order Form.
MDS AND PCP FORM – VERIFY MISING INFORMATION
- Confirm that the member identifiers match.
- Member ID, Member’s Name, Date of Birth, and Social Security are some examples.
- PCP Order Form and MDS – Information about activities of daily living (ADLs) and behaviors should be consistent across both documents.
- If office visit notes are attached to the PA, please make sure that the office note is consistent with the AFC provider Registered Nurse (RN) clinical documentation.
- Schedule and track visits in real time.
- Schedule new visits, view upcoming visits, document missed visits and much more.
- Automatic updates.
- Color-coded calendar to plan your time.
- Verify visits at the point of care.
- Capture patient signatures.
- Ensure compliance and eliminated potential fraud.
- Real-time access to care plans.
- Easily document with just one hand.
CARE LOG
- Caregiver Schedule – Includes – Level of Care, Medical, Non Medical and Alternative Caregiver Leave Records.
- Care Log - Completed and Missing.
- Missing Care Log Signature – Care Manager, Registered Nurse, Caregiver.
CLAIMS
- Eligibility Expiration.
- Tracking - Medical Leave, Non Medical Leave, Alternative Caregiver Documentation.
- Claim Submission - Primary Caregiver, Alternative Caregiver, Medical and Non-Medical leave.
- Denial Report
OPERATIONAL
- Appointment Visit Log - By Care Manager and Registered Nurse.
- Appointment Visit Notes - Progress Notes, Visit Notes, Plan of Care, MDS Evaluation,
Home Assessment.
Analyze, assess and continuously improve performance
- Maximize reimbursements, improve accuracy and save time by ensuring accurate claims.
- Compliance driven workflows help you stay survey ready and compliant.
- Allow clinicians to finish documentation quickly anytime, anywhere.
- Multiple filter options within our QA center eliminate overlap and work duplication.
Care Team Member Records
- Sex Offender Registry Information (SORI) check.
- Criminal Offender Record Information (CORI) check.
- Office of the Inspector General s List of Excluded Individuals (OIG) check.
- Qualified Staff information (Reference checks, job history, education, Licenses etc.)
