Transportation Provider Forum

Transcription

1 Transportation Provider Forum Monday, August 18 La Crosse and Black River Falls Tuesday, August 19 Madison Thursday, August 21 Waukesha and Random Lake

2 General Updates Housekeeping Phones & Restrooms Welcome Introduce Care Wisconsin Team Review of Folder Material

3 General Updates Provider Help Desk Number Will assist with: - Member eligibility - Claims Submission - Billing Process -Hours Monday thru Friday 8am 11:30 am and Noon 4pm

4 Transportation Scope of Service Effective September 1, 2014 New Scope of Service New template for identifying member transportation need and inserted into the Service Authorization

5 Transportation Scope of Service Why the Scope of Service Volume of rides, number of transportation providers, billing discrepancies State and Federal expectations of MCOs to ensure provider training

6 Scope of Service Provides Consistency in service among all contracted transportation providers Delivery Expectations Stronger communication Point of reference for providers

7 Scope of Service Provides Definition Transportation services Standards of service Training Competency requirements Collaboration Coordination of care directions Description of billable units

8 Scope of Service Review Standards, Training and Competency Care Wisconsin Contract Expectations Collaboration and Coordination of Care Billable Units

9 Standards, Training and Competency Standards Meet requirements of any and all applicable licensing, certification and city permits Drivers to have appropriate operator s license(s) from DOT Vehicles to be Mechanically sound with properly functioning lighting Safety ventilation and braking system Properly inflated tires without excessive wear

10 Standards, Training and Competency Standards Maintain adequate staffing, vehicles, routes and scheduling methods to meet the needs Establish expectations with employed or subcontracted drivers to take the shortest and most direct route

11 Standards, Training and Competency Driver Training Requirements Competent in use of vehicle How to recognize and report vehicle maintenance needs Mechanical systems needed to operate the vehicle (lights, safety belts, tires, heaters, tie downs and lifts for wheelchair transportation) Proper use of member safety systems and specific support needs of the individual being transported

12 Standards, Training and Competency Driver Training Requirements Training on population being served Frail Elder, Physically Disabled and Developmentally Disabled Provider agency s recording and reporting requirements for documentation Training on rights and confidentiality (HIPAA) of individuals supported

13 Standards, Training and Competency Driver Training Requirements Training of prevention, exploitation, emotional, verbal, physical and sexual abuse Training on interpersonal and communication skills and appropriate attitudes for working effectively with members

14 Standards, Training and Competency Competency Provider shall ensure drivers competent and assurance of the general skills and abilities to provide the service

15 Care Wisconsin Contract Expectations Transportation providers will provide services as identified and authorized by IDT Transportation providers may not limit or deny any member transportation services due to dissatisfaction with their contracted rate All standards established for contracted providers apply to subcontracted providers whether a vehicle is owned by provider or subcontractor

16 Care Wisconsin Contract Expectations Refer to the following sections of the Agreement for Services Section III Term and Termination and Section VI Certification 6.2 and 6.3 Section VIII Cooperation 8.6

17 Care Wisconsin Contract Expectations Refer to the following sections of the Agreement for Services Section XI Insurance and Indemnification 11.1 Section XIII Records 13.4 Section XXII Fraud, Waste and Abuse 22.3

18 Care Wisconsin Contract Expectations Standards for Subcontractors All documentation requirements apply to subcontractors Requirements for shortest and most direct route apply to subcontractors All background check and insurance requirements apply

19 Collaboration & Coordination of Care Documentation Provider shall retain all transportation records for 7 years Records to include: Member name, pick up and drop off location addresses and units billed to provide each trip Method of verifying the service is provided as assigned and scheduled Care Wisconsin retains the right to audit transportation services How staff training is tracked

20 Collaboration & Coordination of Care Resource Allocation Decision (RAD) A tool Care Team uses to assess member needs and outcomes Care Team shares pertinent information with provider at time referral Ensure health and safety needs met Pick up and destination address Amount of authorized units as relates to each transportation service

21 Transportation Template Transportation Comments Template Administrative Assistant Phone: Click here to enter text. Member Home Address: Click here to enter text. Member Phone Number: Click here to enter text. Mobility Status: Click here to enter text. Special Needs: Click here to enter text. Medical Escort: Click here to enter text. Pick Up Location: Click here to enter text. Destination: Click here to enter text. Second Destination: Click here to enter text. Mileage One Way Trip: Click here to enter text.

22 Transportation Template Key points on new template Will not be used for pre-purchased tickets/passes Will not be used for other service codes that include transportation Day Center Treatment or Prevocational Services Template will be completed to the extent the information is known Roll out is September 1 for new transportation authorizations Phased roll out September to February for existing authorizations

23 Service Authorization

24 Billable Units Contracted rates incorporate all administrative and business functions (agency staffing, training, orientation, and supervision) Reference Appendix A of contract to determine codes, units, and rates. Specifies which transportation service Care Wisconsin is purchasing.

25 Billable Units Billable Units Only units of service directly related to the authorized member may be billed Only one provider agency is billable for the same service at the same time Services must be authorized and provided under the requirements of the contract and the service authorization to be billable to Care Wisconsin Providers are prohibited from billing fraudulently for additional services during the provision of the service if not authorized

26 Providers Thank You Website for Training Module groups Questions Comments