INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT
QIO Request Submission
Requirements
New 6/14/2012
Topics
• Service Type(s)
• KePRO SCDHHS Website
• Service Type
Requirements
• Contact Information
Prior Authorization Service
Types
• PRTF-Psychiatric Residential Treatment
Facility (under 21)
• Freestanding Inpatient Psychiatric (under
21 YO & over 65)
Forms
Navigate to Forms TAB
to obtain Documents
PRTF Fax Form
PRTF Fax Form
PRTF Fax Form
Freestanding Psychiatric
Inpatient (under 21) Fax Form
PRTF
PRTF
Psychiatric Residential Treatment Facilities (PRTFs)
are facilities, other than a hospital, that provide
psychiatric services to children under age 21 in an
inpatient setting. PRTFs provide Inpatient Psychiatric
Services to children under 21 who do not need acute
inpatient psychiatric care, but need a structured
environment with intensive treatment services.
PRTF admissions must be prior authorized by
KEPRO
PRTF
Required Documentation for Provider’s Records:
CALOCUS
Must be completed and current within 90 days prior to
requested start date
Certificate of Need (CON)
Valid for 45 days from the date it is completed
30 day treatment plan
Plan must be created within first 14 days
Required documentation to submit to KePRO:
PRTF Fax form
Provider will attest to information from CALOCUS and CON
30 day treatment plan
Plan must be created within first 14 days
Additional clinical
LENGTH OF APPROVAL
• Requests initially approved for a 21-day
stay.
• Continued stay requests approved for a
30-day stay.
• Time limits apply to SUBCLASS
recipients.
OVERLAPPING REQUESTS
• Requests for services will not be
approved with overlapping dates.
 If for same facility, new approval period will
not be approved until the old approval has
ended.
 If for a different facility, the first-approved
facility must send in notice of discharge prior
to new approval being issued.
PRTF
Criteria
• Initial Admission
– McKesson Interqual Psychiatric Residential
Treatment Level of Care Functioning criteria
– SCDHHS Psychiatric Hospital Services Provider
Manual
CRITERIA FOR PRTF ADMISSION
• Current diagnosis
• Symptoms/behaviors (length experienced
and intensity)
• Prior treatment history
• Support system
• Functioning – How illness affects
performance of ADLs and relationships
with others.
PRTF - CONTINUED STAY REQUESTS
For initial continued stay request, please submit
by day #14 of current authorization.
Requires treatment plan which has been updated
within previous 90 days.
Initial continued stay review must include
documentation of:
• Psychiatric Evaluation within 60 hours of admit
• Psychological Evaluation within 30 days of admit
PRTF - CONTINUED STAY REQUESTS
All Continued Stay Requests must include
documentation/attestation of:
• Individual Psychotherapy at least 90 minutes per
week
• Group Psychotherapy at least 3 times a week
• Family therapy at least once a month for face-to-face
sessions (or documentation as to why this has not
occurred).
• Face-to-face meeting once per month with facility
physician/psychiatrist.
PRTF - CONTINUED STAY REQUESTS
After 12 months (365 days), a new case will need
to be set up and a new review completed.
Documentation must include:
• New CALOCUS
• Treatment plan updated within previous 90 days.
• Meet McKesson Interqual for continued stay
FREESTANDING PSYCHIATRIC
INPATIENT
(UNDER 21 & OVER 65)
AUTHORIZATION
Effective 9/11/2014
Requests to Freestanding Psychiatric
Facilities will be authorized for a one-day
duration,
(instead of 30 days).
DOCUMENTATION
• If submitting by FAX, use Inpatient Prior
Authorization Fax Form.
• In Box 16, mark Service Type as
Freestanding Inpatient Psychiatric
DOCUMENTATION
• Submission of Certificate of Need (CON)
is required or attestation of CON on fax
form, box 23 . This form is valid for 45
days.
• Submitted clinical information will be used
to meet criteria in McKesson Interqual to
substantiate medical necessity of inpatient
admission.
CRITERIA
• Inpatient Freestanding Psychiatry
• Must meet criteria for either:
– Immediate Safety Risk
– Potential Safety Risk
IMMEDIATE SAFETY RISK
• Symptoms within previous 48 hours.
• Recipient is exhibiting symptoms that lead
to immediate concern of decreased safety
for recipient or other people.
Example: Suicidal with definite plan
POTENTIAL SAFETY RISK
• Symptoms present within last week that
lead to concern over recipient’s safety.
• As this is less urgent, requires more
detailed documentation of medical
necessity.
POTENTIAL SAFETY RISK
• Clinical to be submitted includes:
– Symptoms/circumstances that cause concern
– Social risk; changes within previous month in
relationships with others, role performance
(school) or residence
– Is recipient expected to adhere to treatment
plan?
– Why is current support system inadequate to
provide care as an outpatient?
ADOLESCENT SUBSTANCE USE
• Freestanding Inpatient Psychiatry
admissions for substance use issues have
a separate set of criteria that must be met.
• Requirements include submission of the
recipient’s history of substance use as
well as behaviors exhibited as a result of
substance use.
CRITERIA – ADOLESCENT SUBSTANCE USE
• Require evidence of impairments in:
– Relationships – such as a negative peer
group or gang involvement, or increased
conflicts with others.
– Role performance – How has substance use
affected education?
CRITERIA – ADOLESCENT SUBSTANCE USE
• Admission to a residential treatment
center for substance use issues also
requires information on:
– Prior treatment history
– Issues in current social/home setting that
places the recipient at increased risk
– Support system
INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT
Registration for
Atrezzo Connect
Provider Portal
How To Register For
Atrezzo Connect
• Website Address:
https://scdhhs.kepro.com
• Select “ Registration For Atrezzo
Connect” (Slide 3)
• Enter your 10 digit National
Provider Identifier (NPI) number
and Legacy South Carolina
Medicaid provider ID
• Select a unique user name and
password & complete required
user information
Atrezzo Connect
Atrezzo Connect allows for:
– Secure access to Atrezzo
Connect (Provider Portal)
– Provider will be able to
access letters by
Case/Request,
Respond/Send messages
To/From KePRO
Required Information for
Security Verification
• The provider must enter
information to verify
authenticity for security
reasons
• Registration Code:
– SCDHHS Legacy ID
Simple -5 Step Registration Process
• Start by clicking the
Atrezzo Login
button on the
SCDHHS-KePRO
website
Login Page
• You will be brought to this login page
Step 2 – Enter NPI and Legacy ID
• Enter your
organization’s
NPI number and
Legacy Provider
ID = Provider
Registration
Code
• Click NEXT
Step 3 – Terms of Agreement
• Review Terms of
Agreement. Upon
acceptance, you will
be taken to setup for
User information.
Step 4 – Verify Address
• Click on the correct address(s) for the
new account (this associates your user
information with these locations)
• If all apply, check all of them
• Click SELECT
Step 5 – Enter Account Information
• Enter user account
information
• User Name, Password,
First/Last Name, E-mail
and Fax Number are
required fields!
• Click NEXT-This will
take you to the
Password setup and
security question Slide)
• Passwords do not
expire. Minimum 8
characters required.
Successful Completion
• Successful
Completion of
setup, takes
you to the
Home Page
View all request and Create new request
•Click Member to search using Member id or Last
name/DOB
•Click Request/Case to search using Case id,
Member info or Request info
Create Preferences, Manage User account
and New Provider Registration
Use this tab to change your password or
update your contact information
View Atrezzo User Guide and View FAQs
Account Administrator
• All information submitted for
registration under
Provider/Facility Information will
represent as the Provider Portal
Administrator (Group Admin).
• The Group Admin is responsible
for managing and creating all
Submitting User accounts for
your NPI #
– Create other Group Admins’ &
Admin Users
– Set Preferences, i.e. Diagnosis
and Procedure codes, etc
KePRO Contacts
Thank You!
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