Memo. Health Care Management. From: Deborah Jenkins, Admissions/Transfer Manager Date: 10/21/2010 Re: HCM October/November/December 2010 Call Schedule

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1 Health Care Management Memo From: Deborah, Admissions/Transfer Manager Date: // Re: HCM October/November/December Call Schedule The attached list is the October/November/December call schedule for the management staff in the Health Care Management (HCM) Admissions/Transfer Unit. If you are experiencing admission authorization difficulties, transfer difficulties or excessive wait times and need assistance to help facilitate your request please contact the designated person on the call schedule. HCM Updates:. Requesting an Admission Please do not request an admission unless the treating physician s has ordered it. The nurse can not make decisions to admit, that is the responsibility of the treating physician. Clinical information to support the need for treatment in an acute care setting should be submitted when requesting the admission in order for the request to be screened appropriately.. Online Discharge Date Entry HAP contracted facilities were given the ability to enter discharge dates via the Online Discharge Application (ODA) on February, 0. Electronic submission of discharge dates will ensure timely claims payment and maintain accurate hospital utilization statistics. Please note if the member was transferred from your facility to another facility HAP will enter the discharge date and it will not appear in the online discharge application listing. If a claim is received without the discharge date in our online system, the claim will be rejected and result in nonpayment. In an effort to avoid this, entry of all discharge dates for the current month must be entered in the online discharge application by the last day of that month in order to ensure accurate and timely claim payment. We have created an Online Discharge Assistance Line to help you with any errors that occur during the discharge entry process. If a discharge date was entered incorrectly or entered on the wrong HAP member please call -- to report the error. Please leave a voice mail message identifying the error type, the member with whom the inaccurate information was entered, the member s HAP number, date of birth, the admission date and your name & contact information. Please allow hours or the next business day from the date the error was reported for the update to be reflected in the online discharge application. Thank you for your continued partnership in this effort.. Health Management Services Holiday Closure Updates: Admissions Department Emergent Admission (Medical/Surgical) Holiday Closure: Please be advised that the admission department for medical/surgical admissions will be closed for the holiday on the following dates: Thanksgiving Day --. The closure will begin at am on // and reopen at am on //. Christmas Eve // and Christmas Day //. The closure will begin at am on December, and reopen at am on December,. New Year s Day //. The closure will begin at am on January, and reopen at am on January,. Page

2 Medical/Surgical Admissions Holiday Closure Instructions During the holiday closures please follow the directions as identified below. If extenuating circumstances arise where you require assistance with a medical/surgical admission during this period please reference the HMS call schedule and page the designated manager on call. Special Online Admission Application (OAA) Instructions The online admission application will be available during the holiday closure to notify HAP of emergent and elective admission. When requesting a medical/surgical admission online during the holiday closure, if an authorization number is not issued by the application and the case pends, please admit the member and Health Alliance Plan will update the pend queue with the auth number when the program re-opens as noted above. If your facility is unable to use the online program you can call HAP when the program opens as noted above. Network Exceptions: Please note if the member is assigned to the Henry Ford Medical Group (HFMG) please follow the instructions below. Henry Ford Medical Group Member (HFMG) If the admission request is regarding a Henry Ford Medical Group member who requires admission and the hospital is not affiliated with the Henry Ford Medical Group, please contact the Henry Ford Hospital Transfer Team by calling --. Please note if the member is assigned to the Detroit Medical Center (DMC) please follow the instructions below. Detroit Medical center (DMC) If the admission request is regarding a Detroit Medical Center member who requires admission and the hospital is not affiliated with the Detroit Medical Center, please contact the Detroit Medical Center Transfer Team by calling Elective Admission department will be closed for the holiday as noted below: Thanksgiving closed / & / will reopen on Monday // Christmas closed // through // and will reopen on Tuesday // New Year s closed // and will reopen for pre-certs Monday // Pre-certs for SNF and Rehab will not be performed on the following days due to holiday closure: Thanksgiving closed / & / will reopen for pre-certs Monday // Christmas closed // through // and will reopen for pre-certs Tuesday // New Year s closed // and will reopen for pre-certs Monday // Inpatient SNF and Rehab Pre-certs Holiday Closure Instructions: Special arrangements have been made with the skilled nursing facilities and inpatient rehab units listed below to accept HAP members from the acute care setting, without prior authorization from HAP, on the days that the HAP Rehab and SNF precertification program is closed. Hospital case managers and discharge planners should follow the steps listed below to ensure appropriate claims payment and to facilitate continued medical management and payment authorization:. Assess the patient for the level of care that is medically appropriate according to InterQual, CMS or HAP criteria.. Ensure that the patient is directed to the appropriate level of care and facility based on the current clinical status and network assignment.. Fax or send via Allscript to HAP the pre-certification information used to determine medical appropriateness, the setting and name of the site selected, prior to the patient s discharge from the hospital. In the event that there are questions or concerns, hospital case managers and discharge planners, skilled nursing facility staff or inpatient rehab unit staff may contact the HAP manager on call on a / basis. The current on call schedule is accessible via the HAP website. Skilled nursing facilities: For all Network assignments, including HFMG and DMC:. Henry Ford Belmont. Henry Ford Roseville. All Heartland facilities. Father Murray Nursing Center Page

3 . The Lakeland Center. Oakwood Dearborn. Boulevard Temple Inpatient Rehab Units: For Henry Ford Medical Group assigned patients:. Henry Ford Cottage. Henry Ford Macomb Clinton. Henry Ford Macomb- Warren. Henry Ford Wyandotte. Children s Hospital Inpatient Rehab Units: For DMC assigned patients:. Rehabilitation Institute of Michigan. Sinai- Grace. Children s Hospital Inpatient Rehab Units: For all other Network assignments:. Beaumont. Providence. Children's. Rehabilitation Institute of Michigan. Genesys. Sinai- Grace. Henry Ford Cottage. St. John Macomb. Henry Ford Macomb Clinton Twp.. St. John Northshore. Henry Ford Macomb- Warren Campus. St. Joseph Mercy Ann Arbor. Henry Ford Wyandotte. St. Joseph Mercy Oakland. Mc Laren. St. Joseph Mercy Pt. Huron. Oakwood Heritage Behavioral Health Admissions Holiday Closure Instructions: Please be advised that the Behavioral Health department for chemical and/or behavioral health admissions will be closed for the holiday on the following dates: Thanksgiving Day --. The closure will begin at am on // and reopen at am on //. Christmas Eve // and Christmas Day //. The closure will begin at am on December, and reopen at am on December,. New Year s Day //. The closure will begin at am on January, and reopen at am on January,. The behavioral case manager will be available during the closure for behavioral admission requests. The behavioral case manager cannot process medical/surgical admissions request. Instructions on how to contact the behavioral case manager on-call are noted below. Instructions on how to process medical/surgical admission requests are noted at the beginning of this memo. Behavioral Health Admissions Instructions If the facility is requesting a mental health or chemical dependency admission, please page the behavioral case manager on call at -0-. If you are unable to reach the behavioral case manager, please contact the back-up behavioral manager on call, by paging Catastrophic Senior Care Management (CSCM) Program HAP Senior Plus members that are admitted to your facility may be enrolled in the Catastrophic Senior Care Management program. Members enrolled in the program are typically frail elderly seniors, who have multifaceted clinical and psychosocial issues and require intense care coordination efforts on the part of their case managers in order to stabilize their clinical condition, and prevent the frequent reoccurrence of emergency room visits and urgent/emergent inpatient hospitalizations. When a member who is enrolled in the CSCM program is admitted to the inpatient hospital setting, the RN Health Care Coordinator is required to obtain a current clinical status and discharge plan from the hospital Utilization Review / Case Management department. As the case manager in the outpatient setting, the RN Health Care Coordinator may also be able to share valuable information with the hospital case manager regarding the member s barriers to care, home situation and Page

4 ability to manage their condition in the outpatient setting. In addition, the HAP Senior Medical Director requires a clinical update on the member for purposes of discussing the member s medical plan of care, as well as discharge plans with the attending physician. We appreciate your assistance in supplying timely clinical updates and partnering with our nurses to effectively coordinate the care of these members.. HAP s In Home Care Program HAP, in partnership with HF Hospices, St John Home Care and Hospice of Michigan, has developed an In Home Care program for members who have difficulty managing their terminal, chronic and/or debilitating illnesses alone. The program differs from traditional home care in that it provides curative and palliative treatment options not available in routine home care visits. The program allows healthcare professionals to refer patients with terminal, chronic and/or debilitating conditions such as End Stage Chronic Pulmonary Disease, Congestive Heart Failure, Metastatic Cancer or Decline and Debility, for comfort-focused care they need for as long as they need it. If you would like to refer a member to our program or would like more information please call - -. Referrals to HAP's In Home Care Program can also be submitted via the hap.org website by logging into the online services and selecting the "Doctors & Hospitals" tab at the top of the page. In the "Doctors & Hospitals" section under the provider tab menu select "Caring for Your Patient". On the "Caring for Your Patient" page go to the "HAP Programs for Healthy Living" section and select HAP's In Home Care Program. A description of the program will appear with a link to the HAP's In Home Care Program referral form. Select the referral link, complete the form and submit it. If the referred member meets the eligibility criteria, the appropriate agency will contact them for services.. HAP FAX Number for clinical reviews and MPRO Appeals Please use fax # of -0 when you have clinical reviews and/or MPRO Appeals to report to HAP. Page

5 Admission Authorization/Transfer Call Schedule Cindy, Director ~ Pager: Deborah, Manager ~Pager: -0- Kimberly, Manager ~Pager: -0- October 0 November - Holiday - Holiday 0 December -- Holiday -- Holiday 0 // Page