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
•
Botox
•
Transplant
•
Therapies (PT, OT, SP)
•
Home Health
•
Mental Health Counseling
•
PRTF/Freestanding Psyc
•
DME
•
Hospice
•
Surgical Procedures
•
Inpatient
Hospice
Hospice Procedure codes
• T1015- GIP General Inpatient Care
• S9126- Routine home Care
• S9123- Continuous home Care
• S9125- Inpatient Respite Care
• NOTE: T2046 – Hospice Room and Board Services do not
require prior approval
Hospice
• General Inpatient Services
– Documentation required for a new admission into
hospice and the request is GIP:
• KePRO Fax Form (unless submitted via portal)
• SCDHHS Election Form (DHHS 149)
• Initial Care Plan – needs to be current
• Supporting Documentation
– Written Certification must be obtain prior to the submission of
the other hospice procedure codes within15 business days or
– If the other codes will not be requested, written certification
must be obtained prior to submitting hospice claims
Hospice
• KePRO Outpatient Fax Form
– Please make sure that all necessary information has
been filled out on the KePRO fax form
– Include all 3 procedure codes (GIP should also be
included if that is the status of the client upon
submission)
– Requests for GIP should be submitted at the time of
inpatient admission, and if approved, will be
approved for a 30 day time span
Hospice
DHHS 149 Form (Medicaid Hospice Election):
– Designate an effective date for the election
period to begin
– For the “S” codes, the request must be
submitted to KePRO within 15 business days of
election of benefits.
– For GIP, submission on day of admission (or
next day for late day admission).
– If not received within 15 business days, the
request will be approved effective the date the
request was received by KePRO
Hospice
DHHS 149 Form
Hospice
DHHS Form 151- Medicaid Hospice Physician Certification
and Recertification
• Form 151 must be obtained within 2 calendar days after hospice
care has been initiated
– Signed by the Medical Director of the Hospice
• If Form 151 is not obtained within 2 calendar days after the initiation
of Hospice care:
– A verbal certification may be obtained within these 2
days
– Form 151 must be obtained prior to submission of a
request for prior authorization
Hospice
DHHS Form 151- Medicaid Hospice Physician Certification and Recertification
Hospice
Required Clinical Documentation:
• Plan of Care
– Goals/Interventions
• Lab results, Diagnostic Tests, any clinical to
substantiate request for hospice services
• Require corroboration from source other
than Hospice that Hospice is appropriate.
Hospice
Other Required Documentation
• DHHS Form 153 (Revocation Form)
• DHHS 154 (Discharge Form)
• DHHS 152 (Change Request Form)
Hospice
• DHHS Form 153- Medicaid Hospice Revocation
•
•
•
•
Complete DHHS form 153
Designate an effective date to revoke Hospice
Submit Form 153 to DHHS within 5 business days of revocation of benefits
Mail a copy of the form to the nursing facility or ICF/MR
• DHHS Form 154- Medicaid Hospice Discharge
• Designate an effective date to discontinue Hospice
• Submit form to DHHS within 5 working days of the effective date of discharge
• DHHS Form 152- Medicaid Hospice Provider Change
Request
• Complete all appropriate portions of Form 152
• Submit a copy of Form 152 to DHHS within 5 business days
• Send a copy to the receiving Hospice Provider within 2 days
Hospice
DHHS Form 153- Medicaid Hospice Revocation
Hospice
DHHS Form 154- Medicaid Hospice Discharge
Hospice
DHHS Form 152- Medicaid Hospice Provider Change Request Form
South Carolina Web Site
Forms
Navigate to Form Tab
to obtain Documents
such as: Fax and
Justification forms
Outpatient Fax Form
KePRO Outpatient Fax Form cont.
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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